Private Health Facilities Research Articles

Self-Medication Knowledge, Attitude and Practice among the Population of Jamshoro City: A Cross-Sectional Study

Background: Self-medication is a globally prevalent practice, with varying degrees of awareness and regulation across different regions. In developing countries like Pakistan, the practice poses significant public health challenges, including the risk of medication misuse and antibiotic resistance. Jamshoro, a city with a diverse demographic and educational landscape, provides a unique setting to explore the knowledge, attitudes, and practices of self-medication among its residents. Objective: This study aimed to assess the extent of self-medication practices among the adult population in Jamshoro, focusing on their knowledge, attitudes, and the types of medications commonly used. It sought to identify potential risks associated with self-medication and propose recommendations for safer practices. Methods: A descriptive cross-sectional survey was conducted from February to April 2023, involving 400 participants selected through non-probability convenience sampling. The survey encompassed questions related to demographic information, knowledge about self-medication, attitudes towards its practice, and the frequency and types of medications used. Data were collected using both online questionnaires distributed via Google Forms and face-to-face interviews, ensuring a comprehensive understanding of self-medication behaviors. Ethical approval was obtained from the Research Ethics Committee of Liaquat University of Medical and Health Sciences (LUMHS), with the study adhering to the Helsinki Declaration's ethical standards. Data analysis was performed using SPSS Version 25, utilizing descriptive statistics to summarize findings. Results: The majority of respondents were male (55.5%) and undergraduates (64.5%), with students representing 66% of the sample. A significant portion (87.3%) reported a lack of knowledge regarding self-medication, and 90.3% had never taken medication without a physician’s prescription. About 64% were aware of the difference between over-the-counter (OTC) and prescription drugs, and 82.5% recognized the risk of antibiotic resistance. Self-medication practices were infrequent among participants, with 32.5% engaging in it only occasionally. The study also found a predominant preference for private healthcare facilities (68.5%) over public ones. Conclusion: The findings indicate a substantial knowledge gap regarding self-medication among the population of Jamshoro, despite a general tendency to consult healthcare professionals for medical issues. There is a critical need for public health initiatives to educate the community on safe medication practices, the risks of antibiotic resistance, and the importance of adhering to prescribed treatments.

What Multi-Level Solutions Can Enhance the Financial Literacy of Healthcare Professionals in Kenya?

Financial literacy is a crucial asset within the human capital pool, whether individuals are working within or outside the hospital setting. Professionals in various fields benefit from financial literacy, and the main recipients include individuals, the broader economy, businesses, and the overall financial system. In the context of medical professionals, the expectation is often that they make informed business decisions and effectively manage healthcare facilities. However, a notable challenge is the potential lack of essential skills in financial literacy among these professionals. In Kenya, a considerable number of healthcare professionals face a deficiency in financial literacy skills, hindering their ability to proficiently handle even small businesses in private practices and oversee financial matters in hospital departments, both in public and private healthcare facilities. Consequently, the objective of this study is to present healthcare professionals with a roadmap to identify and address gaps to enhance their financial literacy. A survey was conducted from June to July 2023, involving 339 doctors, including medical doctors, dentists, and pharmacists. The findings were interesting concerning gender performance and global comparisons. Unlike previous studies, female doctors demonstrated a higher financial knowledge, behavior, and attitude, suggesting a well-rounded financial proficiency compared to their male counterparts. At the global level, the descriptive analysis revealed strong financial knowledge, positive attitudes, and prudent financial behaviors among the Kenyan participating doctors compared to the OECD global averages. For example, unlike the OECD global average of 52.5% in financial knowledge and literacy, the findings for the Kenyan counterparts stood at 77%; while the OECD global average for financial attitude was 70%, that of the Kenyan counterparts was at 75%; and compared to the OECD global average of prudent financial behavior of 59%, that of the Kenyan counterparts was 69%. It seems that socio-demographic factors, coupled with financial knowledge, attitudes, and behaviors, intricately influence the financial literacy of healthcare professionals. The findings highlight the importance of implementing multi-level solutions to enhance overall financial literacy among healthcare professionals. These solutions include tailored financial programs, self-paced online courses with interactive elements, and the integration of financial literacy into medical undergraduate and postgraduate training curricula. Keywords: healthcare professionals, financial literacy, Kenya, multi-level solutions

Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys.

Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.

Cesarean sections and sociodemographic disparities in Ecuador: A nationwide study from hospital registries between 2015 and 2022.

This study aimed to analyze sociodemographic factors associated with cesarean sections (c-sections) in Ecuador. Data were extracted from the Ecuadorian National Institute of Statistics and Censuses (INEC). Multivariate binary and multinomial logistic regression analyses were performed to assess sociodemographic factors associated with c-sections overall and with each type of c-section (elective or emergency c-section). This study included 1 118 842 in-hospital deliveries during 2015-2022 in Ecuador, of which 41.3% were c-sections. This exceeds the recommended levels of medical justified c-sections. Those who were older than 20-29 years showed a higher probability for c-sections overall. Regarding ethnicity, Montubios had 57% higher probability for c-sectioned with an adjusted odds ratio (aOR) of 1.57 and a 95% confidence interval (CI) of 1.45-1.71; while indigenous, black, and white individuals exhibited 73%, 29%, and 21% lower probabilities, respectively. However, this varied according to specific type of c-sections: black individuals had 11% higher probability of elective c-section but 44% lower probability of emergency c-section. Deliveries in private healthcare facilities exhibited significantly higher probabilities of c-sections overall (aOR 15.38, 95% CI 15.20-15.56). Higher probability of emergency c-section was also observed during 2020-2022. Cesarean sections in Ecuador still exceed the recommended levels of medically justified c-sections, highlighting the importance of adopting an approach to childbirth that reduces unnecessary interventions. These results suggest an important role of sociodemographic factors, which aligns with the reported need for multicomponent and locally tailored strategies for addressing c-section overuse. The increase in c-sections during the COVID-19 pandemic (2020-2022) might suggest the influence of external health crises on maternal healthcare.

Blended Tele-mentoring Support for Strengthening Antenatal Care by Private Health care Facilities: FOGSI VISTRIT INITIATIVE.

The objective of the present initiative was to build capacity of health care providers in private sector along with standardisation of care during antenatal period for common antenatal problems of GDM and iron deficiency anaemia in private sector. A pilot project for all levels of health care providers including doctors, nurses, counsellors and laboratory technicians of 34 private facilities in six districts of Jharkhand was planned. Training modules for GDM and anaemia based on government of India guidelines were developed. End line evaluation included data collection and descriptive analysis of quantitative data quality scores from assessment standards on GDM and anaemia in pregnancy. Knowledge assessment of health care providers and doctors through baseline and end line knowledge assessment survey questionnaire showed that 100% health care providers who were trained scored 85% or more in knowledge assessment questionnaires as seen by baseline and end line questionnaire results. All project hospitals (n = 34) in Jharkhand achieved quality standards of care in intervention period for gestational diabetes mellitus and anaemia in pregnancy. They achieved total score more than 80% and exceeded target of 80% of the quality standards. A systematic strengthening of private health care facilities through a blended tele-mentoring and onsite support is possible. The online version contains supplementary material available at 10.1007/s13224-023-01866-5.

Responding to preventable causes of maternal and perinatal deaths in Homabay County

Background: The Kenya population and housing census (2019) ranked Homabay County among the 15 counties with the highest maternal mortality rate (MMR) of 516 deaths in 100,000 livebirths and neonatal mortality rate (NMR) of 26 in 1,000 livebirths. Baseline assessment reported gaps including dysfunctional maternal and perinatal death surveillance and response system, and untimely perinatal deaths audited. Other challenges contributing to near misses and mortality include erratic availability of blood/blood products, staff shortages affecting the offering of CEmONC services, interfacility referral challenges, not exploiting partnerships with private and faith-based health facilities in the county, and HCW knowledge and skills deficit, especially in management of common causes of death, such as postpartum hemorrhage and eclampsia Methods: MCGL’s objective was to work with the County’s leadership to revitalize the MPDSR system and work toward responding to the causes and avoidable factors contributing to the high burden of maternal and perinatal deaths in the County. MCGL trained HCWs on harvesting and handling of blood products, management of PPH and eclampsia, development of county referral strategy, linkage to private and faith-based HFs, capabilities, support weekly MPDSR committee meetings, develop, and roll out MPDSR of weekly monitoring tool, formation of QI teams, and support for social accountability activities. Results: Improved implementation of MPDSR action points included increased number of CEmONC health facilities, availability and access to blood during PPH emergencies, and point-of-care ultrasound machines in 13 health facilities. There was notable improvement of timely perinatal deaths of audits 47% (70/152). Conclusions: Deliberate and collective effort by the leadership with close follow-up can improve timely auditing and response , which improves the quality of care for mothers and newborns receiving HFs.

Implications of information heard about Dengvaxia on Filipinos' perception on vaccination

Issues that arose from the Dengvaxia vaccination program in the Philippines in 2017 were followed by a remarkable decline in immunization coverage in the country. This study intended to describe the Filipinos’ perceptions about vaccination after hearing about the Dengvaxia vaccine and the vaccination program and determine its potential relationship with selected demographic factors and other variables such as: health literacy, sources of information on Dengvaxia, information heard about the vaccine, healthcare visits, and perceived health status.The study utilized secondary data derived from a national health literacy survey in the Philippines. A total of 1992 respondents were included in the analysis. Majority were females, had reached college, residing in urban areas, and were unemployed. Most obtained information about Dengvaxia from media, particularly the television and heard that it caused death and prevents dengue. Seventy-one per cent had negative vaccination perception upon obtaining information about Dengvaxia. Sex, residence type, and income were found to be associated with vaccination perception. Females and those living in rural areas were more likely to have a negative vaccination perception while those with the highest income were less likely to have negative vaccination perception. Respondents who heard that Dengvaxia prevents dengue, those who obtained Dengvaxia information from health professionals, and those who visited both public and private health facilities in the last 12 months were less likely to have negative vaccination perception. On the other hand, those with inadequate functional health literacy were more likely to have negative vaccination perception.The study presents the implications of information heard about Dengvaxia on Filipinos' perception on vaccination through selected variables and other factors. The findings are important in designing strategies in communicating health information, building public trust, and in reinforcing policies to improve vaccination uptake.

Surgical System Efficiency and Operative Productivity in Public and Private Health Facilities in Ethiopia: A Cross-Sectional Evaluation.

Global and local health organizations track surgical system efficiency to improve surgical system performance using various efficiency metrics, such as operating room (OR) output, surgical incision start time (SIST), turnover time (TOT), cancellation rate among elective surgeries, and in-hospital surgery wait time. We evaluated the surgical system efficiency and factors affecting the efficiency in health facilities across Ethiopia. A cross-sectional study design with retrospective record review was used to evaluate the surgical system efficiency in 163 public and private health facilities in Ethiopia from December 2020 to June 2021. Experienced, trained surgical clinicians abstracted efficiency data from service registers and patient charts using a pretested tool. A bivariable and multivariable regression analysis was conducted. In the study facilities, 84.11% of the operating tables were functional, and 68,596 major surgeries were performed. The aggregate OR output in both public and private health facilities was 2 surgeries per day per OR table. Operating productivity was shown to be affected by first-case SIST (P=.004). However, of the total 881 surgery incision times audited, 19.86% of the first-of-the-day elective surgeries started after 10:01 am. The SIST was strongly associated with an in-hospital wait time for surgery (P=.016). The elective surgery cancellation rate was 5.2%, and aggregate mean TOT was 50.25 minutes. The mean in-hospital surgery wait time was 45.40 hours, longer than the national cutoff for wait time. In a bivariable analysis, the independent variables that demonstrated association operating room productivity were then inputted into a multivariable regression analysis model. However, none of the predictor/independent variables showed significance in the multivariable regression analysis model. The volume of surgery and overall OR productivity in Ethiopia is low. This calls for concerted action to optimize OR efficiency and improve access to timely and safe surgical care in Ethiopia and other LMICs.

HEALTH SEEKING BEHAVIOUR TOWARDS HYPERTENSION AMONG ADULT TRADERS IN AHIA OHURU MARKET, ABA ABIA STATE

The study examined health seeking behavior towards hypertension among adult traders in Ahia Ohuru Market Aba, Abia State. The state was randomly selected while the market was purposively chosen because it was one of the largest. Thereafter, 342 adult traders were selected by balloting. Information on adults’socio-demographic and health seeking behavior were gathered using questionnaire. Digital automatic blood pressure monitor was used to measure their blood pressures. Frequencies and percentages were used to analyze data collected while association was tested using chi square. Result showed that 35.3% and 14.9% visited private and government health facilities, respectively while 4.1% sought traditional health practitioners and 2.3% faith healers. On self-medication with herbal drugs, 22.5% and 28.1% did that most times when they were ill and for illness they considered severe. For pharmaceutical drugs, 46.5% and 14.2% self-medicated with them when sick and did that for mild illnesses most times, respectively Blood pressure readings revealed that 39.4% had normal, 30.8% were pre-hypertensive and 18.9% and 10.9% had stages I and II hypertension, respectively. Association between adults’ health seeking behavior and blood pressure was positive and significant with visit to private health facility, self -medication with herbal, pharmaceutical drugs and faith healers with X2 and p-values of 12.56; 0.057, 23.67; 0.036, 27.56; 0.027 and 17.34; 0.043, respectively. In conclusion, seeking health care in questionable places or self- medication plus other factors may adversely affect onset and progression of hypertension.

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

AbstractBackgroundRwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.MethodsA secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.ResultsMore than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.ConclusionResults suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.

District health management and stillbirth recording and reporting: a qualitative study in the Ashanti Region of Ghana

BackgroundDespite global efforts to reduce maternal and neonatal mortality, stillbirths remain a significant public health challenge in many low- and middle-income countries. District health systems, largely seen as the backbone of health systems, are pivotal in addressing the data gaps reported for stillbirths. Available, accurate and complete data is essential for District Health Management Teams (DHMTs) to understand the burden of stillbirths, evaluate interventions and tailor health facility support to address the complex challenges that contribute to stillbirths. This study aims to understand stillbirth recording and reporting in the Ashanti Region of Ghana from the perspective of DHMTs.MethodsThe study was conducted in the Ashanti Region of Ghana. 15 members of the regional and district health directorates (RHD/DHD) participated in semi-structured interviews. Sampling was purposive, focusing on RHD/DHD members who interact with maternity services or stillbirth data. Thematic analyses were informed by an a priori framework, including theme 1) experiences, perceptions and attitudes; theme 2) stillbirth data use; and theme 3) leadership and support mechanisms, for stillbirth recording and reporting.ResultsUnder theme 1, stillbirth definitions varied among respondents, with 20 and 28 weeks commonly used. Fresh and macerated skin appearance was used to classify timing with limited knowledge of antepartum and intrapartum stillbirths. For theme 2, data quality checks, audits, and the district health information management system (DHIMS-2) data entry and review are functions played by the DHD. Midwives were blamed for data quality issues on omissions and misclassifications. Manual entry of data, data transfer from the facility to the DHD, limited knowledge of stillbirth terminology and periodic closure of the DHIMS-2 were seen to proliferate gaps in stillbirth recording and reporting. Under theme 3, perinatal audits were acknowledged as an enabler for stillbirth recording and reporting by the DHD, though audits are mandated for only late-gestational stillbirths (> 28 weeks). Engagement of other sectors, e.g., civil/vital registration and private health facilities, was seen as key in understanding the true population-level burden of stillbirths.ConclusionEffective district health management ensures that every stillbirth is accurately recorded, reported, and acted upon to drive improvements. A large need exists for capacity building on stillbirth definitions and data use. Recommendations are made, for example, terminology standardization and private sector engagement, aimed at reducing stillbirth rates in high-mortality settings such as Ghana.

Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021

BackgroundNepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved.MethodsCross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs.ResultsDespite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent.ConclusionsThe slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.

Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data

BackgroundLittle is known about postabortion care (PAC) services in Burkina Faso, despite PAC’s importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso.MethodsData for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15–49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women’s background characteristics.ResultsPAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC.ConclusionsResults indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level—the main source of care for many women—which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.

Experiences of membership in munno mubulwadde (your friend indeed) - a novel community-based health insurance scheme in Luwero district in rural central Uganda

BackgroundCommunity-Based Health Insurance (CBHI) schemes are recognized as an important health financing pathway to achieving universal health coverage (UHC). Although previous studies have documented CBHIs in low-income countries, the majority of these have been provider-based. Non-provider based schemes have received comparatively less empirical attention. We sought to describe a novel non-provider based CBHI munno mubulwadde (your friend indeed) comprising informal sector members in rural central Uganda to understand the structure of the scheme, the experiences of scheme members in terms of the perceived benefits and barriers to retention in the scheme.MethodsWe report qualitative findings from a larger mixed-methods study. We conducted in-depth interviews with insured members (n = 18) and scheme administrators (n = 12). Four focus groups were conducted with insured members (38 participants). Data were inductively analyzed by thematic approach.ResultsMunno mubulwadde is a union of ten CBHI schemes coordinated by one administrative structure. Members were predominantly low-income rural informal sector households who pay annual premiums ranging from $17 and $50 annually and received medical care at 13 scheme-contracted private health facilities in Luwero District in Central Uganda. Insured members reported that scheme membership protected them from catastrophic health expenditure during episodes of sickness among household members, and especially so among households with children under-five who were reported to fall sick frequently, the scheme enabled members to receive perceived better quality health care at private providers in the study district relative to the nearest public facilities. The identified barriers to retention in the scheme include inconvenient dates for premium payment that are misaligned with harvest periods for cash crops (e.g. maize corn) on which members depended for their agrarian livelihoods, long distances to insurance-contracted private providers, falling prices of cash crops which diminished real incomes and affordability of insurance premiums in successive years after initial enrolment.ConclusionMunno mubulwadde was perceived by as a valuable financial cushion during episodes of illness by rural informal sector households. Policy interventions for promoting price stability of cash crops in central Uganda could enhance retention of members in this non-provider CBHI which is worthy of further research as an additional funding pathway for realizing UHC in Uganda and other low-income settings.

Nationwide study of in-hospital maternal mortality in Ecuador, 2015-2022.

This study aimed to analyze estimates of in-hospital delivery-related maternal mortality and sociodemographic factors influencing this mortality in Ecuador during 2015 to 2022. Data from publicly accessible registries from the Ecuadorian National Institute of Statistics and Censuses were analyzed. Maternal mortality ratios (MMRs) were calculated, and bivariate and multivariate logistic regression models were used to obtain unadjusted and adjusted odds ratios. There was an increase in in-hospital delivery-related maternal deaths in Ecuador from 2015 to 2022: MMRs increased from 3.70 maternal deaths/100 000 live births in 2015 to 32.22 in 2020 and 18.94 in 2022. Manabí province had the highest rate, at 84.85 maternal deaths/100 000 live births between 2015 and 2022. Women from ethnic minorities had a higher probability of in-hospital delivery-related mortality, with an adjusted odds ratio (AOR) of 9.59 (95% confidence interval [95% CI]: 6.98 to 13.18). More maternal deaths were also observed in private health care facilities (AOR: 1.99, 95% CI: 1.4 to 2.84). Efforts to reduce maternal mortality have stagnated in recent years. During the COVID-19 pandemic in 2020, an increase in maternal deaths in hospital settings was observed in Ecuador. Although the pandemic might have contributed to the stagnation of maternal mortality estimates, socioeconomic, demographic and clinical factors play key roles in the complexity of trends in maternal mortality. The results from this study emphasize the importance of addressing not only the medical aspects of care but also the social determinants of health and disparities in the health care system.

Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe.

Health workers are essential for a functioning healthcare system, and their own health is often not addressed. During the COVID-19 pandemic health workers were at high risk of SARS-CoV-2 infection whilst coping with increased healthcare demand. Here we report the development, implementation, and uptake of an integrated health check combining SARS-CoV-2 testing with screening for other communicable and non-communicable diseases for health workers in Zimbabwe during the COVID-19 pandemic. Health checks were offered to health workers in public and private health facilities from July 2020 to June 2022. Data on the number of health workers accessing the service and yield of screening was collected. Workshops and in-depth interviews were conducted to explore the perceptions and experiences of clients and service providers. 6598 health workers across 48 health facilities accessed the service. Among those reached, 5215 (79%) were women, the median age was 37 (IQR: 29-44) years and the largest proportion were nurses (n = 2092, 32%). 149 (2.3%) healthcare workers tested positive for SARS-CoV-2. Uptake of screening services was almost 100% for all screened conditions except HIV. The most common conditions detected through screening were elevated blood pressure (n = 1249; 19%), elevated HbA1c (n = 428; 7.7%) and common mental disorder (n = 645; 9.8%). Process evaluation showed high acceptability of the service. Key enablers for health workers accessing the service included free and comprehensive service provision, and availability of reliable point-of-care screening methods. Implementation of a comprehensive health check for health workers was feasible, acceptable, and effective, even during a pandemic. Conventional occupational health programmes focus on infectious diseases. In a society where even health workers cannot afford health care, free comprehensive occupational health services may address unmet needs in prevention, diagnosis, and treatment for chronic non-communicable conditions.

The unseen use of antimicrobials: Drivers of human antibiotic use in a community in Thailand and implications for surveillance

ABSTRACT We investigated sociocultural and economic drivers of human antimicrobial use (AMU) in Thailand through ethnographic research, interviews, focus groups and a cross-sectional survey. This community-based study generated findings clustered around three key themes: treatment-seeking practices, medicine use, and interpretation of biomedical constructs. Participants sought care from public health facilities for chronic conditions, but medicines from the private sector were considered more powerful and were preferred for acute complaints. Many antibiotics were unrecognised as such by consumers due to the practice at private healthcare facilities of dispensing repackaged medicines without identifying labels. This unseen use of antibiotics is probably driven by economic drivers including market competition in the private sector, policy implementation drivers whereby rational drug use policies mainly target the public sector, behavioural drivers relating to treatment seeking-practices, and sociocultural drivers that influenced participants’ understanding of medical terms and concepts. Participants regarded antibiotics as reducing inflammation and were uncertain about the distinctions between anti-inflammatories, antibiotics, and pain relievers. Antimicrobial Resistance (AMR) was understood as a form of drug tolerance to be remedied by changing the medicine. Community surveys may not provide accurate estimates of AMU where people are unable to distinguish antibiotics reliably from other medicines.

“What if I get sick, where shall I go?”: a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya

BackgroundGlobally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM’s healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM.MethodsIn September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12.ResultsParticipants were 18–24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM’s experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention.ConclusionDuring engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.

Factors Associated with Utilization of COVID-19 Preventive Measures by Patients Attending Private Healthcare Facilities in Southwest Nigeria

Background: Understanding disease risk is important for prevention. Identifying high-risk COVID-19 patients helps healthcare professionals implement precautions. This study examined factors related to COVID-19 prevention in patients at private healthcare facilities in Southwest Nigeria, during the early stages of the pandemic. Methods: A descriptive cross-sectional survey was conducted in two hospitals using multi-stage sampling. 400 respondents were selected two out of 78 private healthcare facilities in in Southwest Nigeria. Trained interviewers administered a questionnaire to collect information on risk profile, symptoms, perception of COVID-19 risk, and preventive practices. Data was analyzed using descriptive statistics, chi-square test, and binary logistic regression at a significance level of 0.05. Results: The average age of participants was 27.83 + 10.46 years. 52.8% of respondents were female. 70.5% were single, 75.8% belonged to the Yoruba ethnic group, and 72% identified as Christians. None had a history of international travel or contact with a confirmed COVID-19 case in the past 14 days, but 12.75% had been in contact with suspected cases. 47% reported having a fever. The majority had a low risk score for COVID-19. Most did not smoke (98.5%), consume alcohol (83.75%), or visit club houses (85.75%). Only 9.5% underwent COVID-19 testing, and 16.0% of those tested were positive. The main reason for test refusal was a lack of perception of susceptibility to COVID-19. Adherence to preventive practices was poor in all investigated circumstances. Conclusion: Patients presenting in hospitals during the early phase of the COVID-19 pandemic had a low risk of COVID-19. However, their poor compliance with preventive protocols and low testing uptake make them a potential source of transmission. Strategies to promote adoption of preventive measures are needed, especially among patients at private healthcare facilities.

Adoption of Emerging Web-Technologies by Medical Doctors in Enugu Metropolis, Enugu State

Emerging web-technologies play pivotal role in advancing remote patient monitoring and telemedicine services in various ways that are currently transforming healthcare delivery. Adoption of these technologies by medical doctors in their medical practice is generally considered as important for improved healthcare delivery. This study examined adoption of emerging web-technologies by medical doctors in Enugu metropolis, Enugu State. Two research questions guided the study. The study adopted a descriptive cross sectional design. The population of the study was selected 10 health facilities is Enugu metropolis. The sample of the study comprised 150 medical doctors drawn from the public and private health facilities in Enugu metropolis. The instrument for data collection was a questionnaire. The data collected from questionnaires was analysed using frequencies, percentages, and chi-square test. Findings of the study revealed that majority of the medical doctors, 63.33% utilize patient remote monitoring devices to facilitate health care services. Also, majority of the medical doctors, 51.33% utilize telemedicine to facilitate health care services. Results showed that gender and practice-locations of medical doctors had significant association to the level to which they utilize patient remote monitoring devices to facilitate healthcare services. The study recommended that health policy makers should develop and implement ongoing training programmes for medical professionals to enhance their proficiency in using remote patient monitoring devices and telemedicine. This will ensure that healthcare providers stay updated on the latest features and functionalities of these web-technologies for maximal benefits. Government should recognize and address issues related to internet connectivity and infrastructure, particularly in remote or underserved areas. Improving broadband access and reliability will ensure seamless telemedicine interactions and also broaden its reach to a wider population.