Private Health Facilities Research Articles

Geographic and socioeconomic inequities in cesarean delivery rates at the district level in Madhya Pradesh, India: A secondary analysis of the national family health survey-5

ABSTRACT Background In India, caesarean delivery (CD) accounts for 17% of the births, of which 41% occur in private facilities. However, areas to CD in rural areas are limited, particularly for the poor populations. Little information is available on state-wise district-level CD rates by geography and the population wealth quintiles, especially in Madhya Pradesh (MP), the fifth most populous and third poorest state. Objective Investigate geographic and socioeconomic inequities of CD across the 51 districts in MP and compare the contribution of public and private healthcare facilities to the overall state CD rate. Methods This cross-sectional study utilised the summary fact sheets of the National Family Health Survey (NFHS)-5 performed from January 2019 to April 2021. Women aged 15 to 49 years, with live births two years preceding the survey were included. District-level CD rates in MP were used to determine the inequalities in accessing CD in the poorer and poorest wealth quintiles. CD rates were stratified as <10%, 10–20% and >20% to measure equity of access. A linear regression model was used to examine the correlation between the fractions of the population in the two bottom wealth quintiles and CD rates. Results Eighteen districts had a CD rate below 10%, 32 districts were within the 10%–20% threshold and four had a rate of 20% or higher. Districts with a higher proportion of poorer population and were at a distance from the capital city Bhopal were associated with lower CD rates. However, this decline was steeper for private healthcare facilities (R2 = 0.382) revealing a possible dependency of the poor populations on public healthcare facilities (R2 = 0.009) for accessing CD. Conclusion Although CD rates have increased across MP, inequities within districts and wealth quintiles exist, warranting closer attention to the outreach of government policies and the need to incentivise CDs where underuse is significant.

Determination of Antibiotic Prescription Pattern in Private Healthcare Facilities in Port Harcourt Metropolis, Rivers State, Nigeria

Background: The consequences of antimicrobial resistance are severe, as mortality and morbidity rates continue to increase. The extensive use of antibiotics contributes significantly to the development and spread of antimicrobial resistance. It is crucial to have knowledge supported by data to improve antimicrobial stewardship and address the growing problem of antimicrobial resistance globally and locally. Thus, an evaluation was conducted to assess the prescription practices of doctors working in private medical facilities in Port Harcourt, Rivers state, Nigeria.&#x0D; Methods: A cross-sectional survey was carried out using a structured questionnaire to collect information on medical training and antibiotic prescription practices among 102 medical doctors. Data was analyzed at a 95% confidence interval using the SPSS v25 software and a p-value less than 0.05 was considered significant.&#x0D; Results: The respondents' demographics indicated that 67.6% were male, while 32.4% were female practitioners. The majority, about 60.8%, had MBBS only, while 21.6% had a postgraduate medical fellowship and 17.6% had postgraduate degrees (PGD/MSc/PhD). The data revealed that 35.3% of the respondents had practiced for at least 15 years, while 33.3% had practiced for 1-5 years and 23.5% for 6-10 years. Cephalosporins were commonly prescribed by 43.1% of the respondents, with cefuroxime being the most frequently prescribed. Amoxicillin was prescribed by 20.6% of the respondents, while only 2.9% of them indicated prescribing Penicillins V or G. Laboratory investigations were the basis for prescribing antibiotics in 30.4%, while 69.6% prescribed on an empirical basis. The cross-tabulation of basis of prescriptions with qualifications showed that persons with postgraduate medical fellowship (86.4%) mostly prescribed based on clinical judgment, while individuals with MBBS only least commonly prescribed by clinical judgment. The prescription by empirical assessment was also mostly common among individuals with 6-10 years of practice experience (75%). However, no statistically significant association was found between the basis of prescriptions and academic qualifications or years of practice.&#x0D; Conclusion: The study's results revealed that doctors in private medical facilities in Port Harcourt have a strong inclination towards prescribing cephalosporins, particularly on empirical grounds rather than laboratory investigations. It is highly recommended to take immediate measures to promote the implementation of antimicrobial stewardship principles to address the local rise in antimicrobial resistance.

Contracting the private health sector in Thailand's Universal Health Coverage.

Private sector plays an import role in health service provision, therefore the engagement of private health facilities is important for ensuring access to health services. In Thailand, two of the three public health insurance schemes, Universal Coverage Scheme and Social Health Insurance, contract with private health facilities to fill gaps of public providers for the provision of health services under Universal Health Coverage. The National Health Security Office (NHSO) and Social Security Office (SSO), which manage the schemes respectively, have designed their own contractual agreements for private facilities. We aim to understand the current situation of contracting private health facilities within UHC of the two purchasing agencies. This qualitative descriptive case study was conducted through document review and in-depth interviews with key informants to understand how they contract private primary care facilities, service types, duration of contract, standard and quality requirement and renewal and termination of contracts. Private providers make a small contribution to the service provision in Thailand as a whole but they are important actors in Bangkok. The current approaches used by two purchasers are not adequate in engaging private sector to fill the gap of public provision in urban cities. One important reason is that large private hospitals do not find public contracts financially attractive. NHSO classifies contracts into 3 categories: main contracting units, primary care units, and referral units; while SSO only contracts main contracting units. Both allows subcontracting by the main contractors. Contractual agreements are effective in ensuring mandatory infrastructure and quality standards. Both purchasers have established technical capacities to enforce quality monitoring and financial compliance although there remains room for improvement especially on identifying fraud and taking legal actions. Contracting private healthcare facilities can fill the gap of public healthcare facilities, especially in urban settings. Purchasers need to balance the right level of incentives and accountability measures to ensure access to quality of care. In contracting private-for-profit providers, strong regulatory enforcement and auditing capacities are necessary. Further studies may explore various aspects contracting outcomes including access, equity, quality and efficiency impacts.

Job strain during covid-19 in private healthcare facilities sousse: prevalence and associated factors (tunisia)

Job strain during covid-19 in private healthcare facilities sousse: prevalence and associated factors (tunisia)

Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India

IntroductionOutpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan.MethodsIt was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey.AnalysisThe focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services.ResultExcept for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine.ConclusionThe uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.

Knowledge of tropical diseases and response capabilities of healthcare providers in Kaduna State, Nigeria.

The public health impact of neglected tropical diseases (NTDs) is quite substantial. The objective of this study was to assess the knowledge and response capability of health professionals regarding NTDs in Kaduna State, Nigeria. A pre-tested questionnaire with a Cronbach's α coefficient of 0.716 was administered to 350 health professionals. The questionnaire assessed the knowledge, resource availability and capacity to handle NTD cases. Only 38 (12.6%) respondents were familiar with the World Health Organization's definition of NTDs. Although self-reported knowledge was highest for physicians (37 [82.2%]), there was no statistically significant knowledge disparity between cadres of health professionals. Only 12 (46.2%) practitioners in private health facilities reported adequate knowledge. The tier of practice was significantly associated with management of NTDs (χ2=10.545; df 2; p=0.005). Only 24 (47.1%) medical laboratory scientists and 18 (40.0%) physicians had adequate clinical resources for management of NTDs. Nearly three-quarters (211 (70.1%)] of respondents had never been trained in the management of NTDs. More than half (177 [58.8%]) of facilities lacked pharmaceuticals or standard operating procedures for management of NTDs. Self-reported knowledge of NTDs was suboptimal. Physical and clinical resources for the diagnosis and treatment of NTDs were inadequate. Targeted training, increased funding and provision of adequate resources are needed in order to ameliorate the situation.

COVID-19 Vaccine Acceptance and Hesitancy in Health Care Workers in Somalia: Findings from a Fragile Country with No Previous Experience of Mass Adult Immunization.

Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia's federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15-4.90) or a nurse (aOR = 2.12, 95% CI: 1.05-4.25); having a master's degree (aOR = 5.32, 95% CI: 1.28-22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68-6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15-3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02-2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public's willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

IntroductionFor several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10–15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti.MethodsSecondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016–2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population’ characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05.ResultsThe overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8–6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00–1.96); who attended secondary (aOR = 1.95; 95% CI 1.39–2.76) and higher education level (aOR = 3.25; 95% CI 1.92–5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57–4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18–7.85) or 3–4 children (aOR = 2.07; 95% CI 1.09–3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40–3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25–2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48–0.91) were less likely to be delivered through CS than their counterparts with high birth weight.ConclusionsWhile the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women’s health in Haiti should take these disparities into account.

Medical Equipment Maintenance: Why is Prevention better than cure

A wide range of medical equipment are used within medical institutions for prevention, monitoring, diagnosis and treatment, therefore, forming an integral part of the healthcare pathway. For healthcare providers, the proper functioning of these medical devices is of huge importance because of their role in delivering quality services to patients and considering the associated repair costs. Today, budget restrictions within numerous private and public healthcare facilities present a severe issue of patients being treated on ageing equipment, which are often also defective. This defeats the healthcare system’s primary purpose in offering patients quality care. It also risks the operational efficiency and reputation of such medical facilities.

Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach

BackgroundJazan region in the Kingdom of Saudi Arabia (KSA) has been extensively studied regarding access to dental care services, but there is currently no specific study on the distribution of public (primary healthcare centres (PHCs) and hospitals) and private dental healthcare facilities in the area. This study aimed to evaluate the spatial distribution of public and private dental care facilities in the Jazan region in relation to the population distribution in each governorate of the region.MethodsThe most up-to-date, easily accessible, and anonymous data and information were used for this investigation. The Ministry of Health’s (MOH) Statistical Yearbook 2020 and interactive map were used to identify the locations of healthcare facilities. These locations were plotted on a map using Google Maps, and the data was converted to longitude and latitude with 90% level building accuracy. QGIS’s integrated database was used to develop buffer zones and perform attribute analysis. The data was then exported for analysis in Microsoft Excel, where healthcare facility-to-population ratios were determined.ResultsIn Jazan region, consisting of 17 governorates and a population of 1,726,739, there were 275 public and private dental clinics, with a ratio of one dental clinic per 6,279 people in terms of general health services. Only 12.4% of these clinics were located beyond 20 km of the city centre, serving approximately 70% of the region’s population.ConclusionThe uneven distribution of dental clinics in the Jazan region has hampered access to dental treatments and has led to a significant burden on dental health facilities, reducing the quality of care available in the region. Mapping the distribution of MOH, private, and other health facilities, as well as the burden of oral disease in the Jazan region, is necessary for further research.

Caesarean Section Delivery in India: A Comparative Assessment of Geographical Variability Using Nationally Representative Survey Factsheet Data

Background: In line with global trends, India has witnessed a sharp rise in C-section (CS) deliveries, especially in the private sector. Methodology: Study attempts to explore change in CS delivery in India at national, regional and State/UT levels. We have used factsheet data from the most recent nationally representative survey data i.e., NFHS to examine changes in private and public healthcare facilities, and to determine a difference in rural and urban in CS deliveries. Results: The CS rate has increased from 17.2% to 21.5% in 2019-21. CS was more than twice (40.9%) amongst the private healthcare facilities during the fourth round of NFHS which has shown a considerable increase during the fifth round of NFHS (47.4%). There is equal distribution (12.8% during 2015-16 to 17.6% in 2019-21 in rural areas v/s 28.2% during 2015-16 to 32.3% in 2019-21in urban areas) of CS deliveries amongst the rural and urban areas to the total deliveries. Conclusion: Study found that with every one in five deliveries being caesarean, the figure is significantly high as per the recommended cut off by WHO. Thus, it is essential to explore factors regarding emergency or elective caesarean section and to understand if the health facilities are following the recommended protocols for performing CS deliveries.

Disparities in readiness of health facilities to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) in Bangladesh

The considerable success of Bangladesh's family planning programs Slowed in recent years due to the low utilization of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). The low uptake persists despite the fact that these methods are proven to be highly effective in preventing unplanned pregnancies and lowering maternal deaths. This situation causes a daunting challenge for the country to attain sustainable development goals (SDGs) by 2030. The current study provides new insights into the status of LARCs and PMs availability in Bangladesh from the supply-side perspective. The main objective of this study was to assess the readiness of health facilities to provide all LARCs and all PMs in Bangladesh. To assess service readiness, we examined variations in facility types and regions, using data from the Bangladesh Health facility Survey (BHFS) 2017. Out of a total of 1054 health facilities assessed, government health facilities manifested higher availability of items of general service readiness for LARCs and PMs compared to private health facilities. Service readiness included domains including staff and guidelines, equipment, and medicine. Logistic regression models of readiness of LARCs, PMs, and combined LARCs-PMs showed significant variations by facility types and regions. Moreover, the findings of this study highlighted that, Bangladesh government facilities, irrespective of region, were more likely to be ready to provide combined LARCs-PMs, LARCs, and PMs individually than private health facilities. Looking more closely at the overall readiness within private health facilities, we found that it was better in rural areas than in urban areas. The findings of this study provide a basis to develop recommend strategic approaches to family planning programs, investment priorities in family planning services and, training for service providers to reduce regional inequality and disparities by facility types in Bangladesh.

Connaissances attitudes et pratiques du personnel soignant non dermatologue face à la gale à Lomé (Togo)

Background: : The aim of this study was to document the knowledge, attitudes and practices of non-dermatologist health care workers on scabies. Method: We conducted a cross-sectional study among non-dermatologist health workers in public and private health facilities in the city of Lomé. Result: Of the 163 health workers included, 90.8% had a good knowledge of the definition of scabies; and the contributing factors (lack of hygiene, promiscuity) were known by 64.4% of the respondents. Pruritus was known as a major functional sign (92.6%) and the most cited sites of scabies lesions were the interdigital spaces (76.7%) and the buttocks (62.0%). In addition, 83.4% had already diagnosed and managed a case of scabies at least once. Topical scabicides were the most prescribed (86.5%), followed by antihistamines (54.6%); and 39.6% of respondents did not treat the patient’s environment. Conclusion: The knowledge, attitudes and practices of non-dermatologist health care personnel on scabies are low. It is important to organize continuing medical education to bring them up to speed. Key words: knowledge, attitudes, practices, non-dermatologist health care personnel, scabies

Household heads satisfaction and associated factors on community-based health insurance scheme in Gudeya Bila District, Oromia, Ethiopia.

Community-Based Health Insurance (CBHI) scheme refers to a non-profit type of health insurance for the informal sector. There is a paucity of information on this topic in Gudeya Bila, Ethiopia. This study aimed to assess the level of household (HH) satisfaction with the CBHI scheme and its associated factors. A community-based cross-sectional study design was employed from November 1-30, 2020, and a sample of 630 HHs who enrolled in the CBHI scheme were included. A multi-stage sampling and systematic random sampling were employed. Data was entered into Epidata version 3.1 and analyzed using SPSS for windows program version 25. A 95% CI was calculated and variables having p-value < 0.05 were considered statistically significant. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed. All HHs heads (630) with a response rate of 100% were involved in the study. The overall HH satisfaction on CBHI was 56.2%. Attending CBHI scheme-related meetings (AOR = 1.948, 95% CI = 1.16-3.27), healthcare provider respectfulness (AOR = 9.209, 95% CI = 2.73-31.06), able to get the ordered laboratory test service (AOR = 2.143, 95% CI = 1.127-4.072) and having paid extra money for drug supply at private health facilities (AOR = 0.492, 95% CI = 0.285-0.847) were independent predictors. HH satisfaction level on CBHI scheme was moderate. Attending CBHI scheme-related meetings, health-care provider respectfulness, being able to get the ordered laboratory test services and extra payments for drug supply were significant predictors of satisfaction with CBHI. Therefore, attention should be given to increasing the satisfaction of HHs with CBHI through improving the quality of health services.

Predictors of Attrition from Care and Treatment Centres among HIV-positive Pregnant and Breastfeeding Adult Women in Dar es Salaam, Tanzania

In Tanzania, poor retention rates among pregnant and breastfeeding mothers continue to be a problem, contributing to a mother-to-child HIV transmission rate of 11% in 2019, compared to a global target of 5%. The goal of this study was to determine the influence of retention on clinical outcomes and identifying predictors of attrition among HIV-positive pregnant and breastfeeding women from follow-up care in Dar es Salaam. A retrospective cohort study included HIV-positive women who engaged in PMTCT services in public and private health facilities between January 2016 and December 2019. Secondary data were extracted from databases used for routine follow-up in care and treatment clinics (CTCs). The estimates of cumulative incidences of poor retention from date of enrollment or ART initiation were assessed using Kaplan–Meier method. The Cox regression model was used to identify the predictors of attrition. Among 20,225 HIV-infected pregnant and lactating women enrolled in PMTCT services, 93.35%, 89.07%, and 85.24% were classified as retained in care at 12, 24, and 36 months, respectively. The attrition rate at the end of the follow-up period was 15.82%, and WHO clinical stages 3 or 4 (aHR = 1.67, 95% CI: 1.46–1.89; p-value &lt; 0.001) and unsuppressed viral load (aHR = 3.79, 95% CI: 3.20–4.49; p-value &lt; 0.001) were predictors of increased risks of attrition. The maternal age group 25–34 years (aHR = 0.24, 95% CI: 0.18–0.32; p-value &lt; 0.001), being married or cohabiting (aHR = 0.45, 95% CI: 0.38–0.55; p-value &lt; 0.001), an efavirenz (EFV)-based regimen (aHR = 0.26, 95% CI: 0.19–0.35; p-value &lt; 0.001), and good adherence to ART (aHR = 0.61, 95% CI: 0.48–0.79; p-value &lt; 0.001) were factors associated with reduced risks of attrition. The study shows that a strong tracking system for lost to follow-up (LTFU), that is, patients who miss appointments to the same health facility for more than 3 months after the last scheduled clinical visit, should be prioritised for successive PMTCT programmes for better clinical outcomes.&#x0D; Keywords: Retention, Attrition, Treatment, Clinics, Loss-to-follow up

Effectiveness and Challenges: The Current Situation of Electronic Health Records (EHRs) to Improve Health Care Outcomes

Background. In the Philippines, although software for Electronic Health Records (EHRs) is still new, knowledge about EHRs benefits is increasing.Objective: This study investigated the effectiveness of electronic health records to health care outcomes at selected health facilities in the National Capital Region (NCR) and CALABARZON regions of the Philippines. The effectiveness of the current EHRs in government and private health facilities were determined in terms of quality patient care, patient engagement, support team-based care, workload, and data liquidity; and the challenges facing health providers in the implementation of electronic health records were identified.Methods. The research utilized the descriptive, cross-sectional design. Three hundred seven (N=307) health providers from the medical, nursing, and paramedical departments were the study participants. A three-part adapted questionnaire was the main tool used for data collection. Mean, standard deviation, and Mann-Whitney &amp; Kruskal-Wallis’s tests were utilized for data analysis.Results. The results revealed that in the Philippines, EHRs are moderately effective in improving health care outcomes. EHRs effectiveness is primarily achieved through better access and retrieval of health information. EHRs implementation poses major challenges in the Philippines’ health facilities which are central to socio-economic and organizational factors.Conclusions. The more effective the use of EHR systems, the greater the challenges experienced by care providers and health facilities.

FACTORS ASSOCIATED WITH RATIONALITY OF ANTIMALARIA PRESCRIPTION IN PAPUA PROVINCE

Malaria remains a leading cause of death in Papua and combination of Dihydroartemisin -Piperaquine (DHP) and Primaquine (PQ) is recommended treatment to replace chloroquine out since chloroquine resistance present. Moreover, awareness of rational prescription and adherence may be the first priority in malaria treatment in preventing death and resistance in Papua. This study aimed to assess the rationality of antimalaria prescription in the public and private sectors of Papua Province. This cross-sectional study was conducted. Overall, 571 prescriptions were included in this study and more than half of prescription was rational (65%). This study was predominantly female (65%). More than half was diagnosed by P. falciparum (54%), using referred using the public hospital for treatment (54%) and self-identified as Papuan (50%). According to type of malaria, incorrect of prescription DHP and PQ were 20% and 18%, respectively. The multiple logistic regression model showed that female was significantly associated to receive irrational of prescriptions than males (OR = 1.549; 95% CI =1.004-2.389). Participants who had P. falciparum increased the likelihood of irrational of prescriptions (OR= 1.641; 95% CI =1.144-2.355). There is a need to have a continuum strategy to improve access and utilization of malaria case management in both public and private health facilities. Inequality gender based on prescribers needs to be investigated. Competence improvement among healthcare providers needs to be a priority to prevent antimalarial resistance.

Prevalence, Pattern of Disease and Outcome of Children with Sickle Cell Disease Admitted in a Private Health Facility in Southern Nigeria

Introduction: Sickle cell disease, an autosomal recessive genetic disorder is characterized by chronic haemolytic anaemia often leading to life-threatening events triggered by acute sickling of red blood cells and microvascular occlusion resulting in frequent admissions.&#x0D; Aim: To determine the prevalence, pattern of disease and outcome of children with sickle cell disease admitted at a private health facility in southern Nigeria.&#x0D; Study Design: A retrospective study.&#x0D; Place and Duration of Study: Study was carried out at a private paediatric hospital in Port Harcourt, Rivers State over a 1-year period.&#x0D; Methodology: Data was retrieved from the hospitals’ Health Management System. Information obtained were age, sex, diagnosis, indication for transfusion if any, number and types of transfusions, duration of admission, mode of payment of bills and outcome.&#x0D; Results: Out of 1597 admissions, 59 were children with sickle cell disease giving a prevalence of 3.7%. Males predominated with a Male:Female ratio of 1.7:1, majority were £ 5 years (50.8%) and had insurance (86.4%). Most were admitted during the rainy season (61.0%) and had duration of stay of 1 – 5 days (74.6%). Commonest diseases among these children were sepsis (69.5%), vaso-occlusive crises (52.5%), malaria (52.5%) and severe anaemia/hyper-haemolytic crisis (30.5%). Of the 35.6% who received blood transfusion, majority received sedimented cells (81.0%), were transfused once (71.4%) with majorly blood group O Rhesus D Positive blood (44.8%). One child died with mortality rate of 1.7%. Vaso-occlusive crisis and tonsillitis were significantly observed more in older children ³ 12 years whereas there was no statistically significant association between gender and duration of stay with the pattern of disease.&#x0D; Conclusion: Sickle cell disease accounted for 3.7% of total admissions with a mortality rate of 1.7%. Sepsis, vaso-occlusive crisis, malaria and severe anaemia/hyper-haemolytic crisis were the commonest diagnosis. Neonatal screening, parental education, patient compliance, vaccinations, regular follow up, and comprehensive health insurance will significantly reduce morbidity and mortality in persons with Sickle cell disease.

Disrespect and abuse in maternity care in a low-resource setting in Tanzania: Provider's perspectives of practice.

Globally, women experience disrespectful and abusive care from maternity healthcare providers at health facilities, committed intentionally or unintentionally, particularly during labor and delivery. Disrespectful care affects women's childbirth experience and birth outcomes. This study used a descriptive qualitative design to obtain thick and rich data on disrespect and abuse in maternity care in a low-resource setting in Tanzania. Three days workshop was conducted at the Aga Khan University comprising maternity healthcare providers from diverse settings. The workshop was designed based on the existing evidence and anecdotal data and inspired by the authors' experiences of disrespectful and abusive care (stereotyping clients, not listening to client's/relatives' concerns, unconsented care) as a client, relative, or observant of colleagues. The targeted audience was maternity healthcare providers from public and private health facilities in the Dar es Salaam region. Data collection encompassed individual responses (reflection of practice) obtained by individuals, anonymously written reflections of practice, and compiled notes from group discussions. Data were analysed thematically guided by six steps described by Braun and Clerk. A total of 80 maternity healthcare providers participated in the workshop from various health facilities, including dispensaries (n = 25), health centres (n = 2), and hospitals (n = 3) located in semi-urban Dar es Salaam. Four main themes were identified from the data: Physical and verbal abuse; Lack of professional ethics and integrity; Vulnerable working environment; Abuse and disrespect to care providers. In addition, several sub-themes were identified within these themes: Harsh and abusive language; Beating/slapping/pinching of the mother in labor; notably, Junior midwives also disrespected and abused women; Lack of privacy and confidentiality; Poor communication; No consent for maternity healthcare procedures; Lack of courtesy and poor interpersonal skills; and, negligence of care and woman's needs. The actions of disrespect and abuse are alarming in practice and are associated with ignorance of fundamental human rights by both providers and recipients of services. Conducting workshops seems a useful approach to revealing disrespect and abuse deep-rooted in practice and provides an opportunity to rectify the problem with providers. A more extensive interventional study will be crucial to address the widespread actions of disrespect and abuse.

Untreated major depression in healthcare workers: Results from the nationwide AMADEUS survey.

Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes. The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies-Depression Scale was sent to public and private national healthcare facilities. Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4-34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow-up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians. Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs. Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn-over and globally to improve the wellbeing at work.