Private Health Care Research Articles

Comparative Study of Open and Laparoscopic Appendectomy with Complications in Government and Private Sector Hospitals

Background: Patients face a 6% lifetime probability of undergoing appendectomy as an emergency surgical treatment. The surgical treatment methods known as Open Appendectomy (OA) and Laparoscopic Appendectomy (LA) represent the standard approaches for clinical use but each brings specific benefits and restrictions. Significant progress has been made but additional comparative studies are necessary to assess the treatment results together with surgical complications and recovery in different hospital facilities. The research examines outcomes between Open Appendectomy (OA) and Laparoscopic Appendectomy (LA) across government institutions along with private healthcare facilities. Objectives: This project examines the clinical results between OA and LA through evaluations about procedural difficulties alongside pain intensity levels and treatment duration measurements. The secondary analysis measures both surgical operation duration and patients' clinical course by charting hospital stay duration and activity restoration period and adopting patient-based results evaluation. This evaluation seeks to discover whether organizational sector impacts patient results from government sectors compared to private institutions. Methods: This prospective comparative research took place between District Headquarter Hospital and Sandhu Medicare Hospital in Toba Tek Singh, Pakistan. The researcher enrolled 108 appendectomy patients aged between 18 and 50 through random sampling for the study. Patients were divided into two groups based on the surgical approach: OA (n=54) and LA (n=54). A structured questionnaire gathered data for demographic information alongside pre-operative and post-operative metrics and duration of surgery and complications from all participants. The researchers used SPSS software version 24 to run their statistical analysis. Results: Patients within the OA group presented with a mean age of 44.20 years while patients in the LA group maintained a mean age of 44.19 years. Stone operations showed higher male participation than female (62.96% in OA and 61.11% in LA). The duration of surgical procedures measured at 89.22 ± 15.48 minutes in OA and 88.65 ± 18.64 minutes in LA with no significant difference comparison (p=0.8621). The length of hospital stay was comparable between the patients having Open Appendectomy (OA) who spent 5.31 ± 1.04 days (p=0.2364) and patients having Laparoscopic Appendectomy (LA) who stayed 5.56 ± 1.06 days. The incidence of postoperative wound infection reached 37.04% in patients receiving open appendectomy whereas the patients undergoing laparoscopic appendectomy showed no infections (p<0.05). A greater percentage of patients received general anesthesia during Open Appendectomy (54%) compared to Laparoscopic Appendectomy (46%) representation (p=0.0101). Alternative methods for postoperative pain control revealed equivalent results between groups according to assessments of pain scores and administered analgesic dose measurements. Conclusion: The surgical procedure Laparoscopic Appendectomy performed better after operations due to its decreased wound infections and equal recuperation results which established it as a safer choice than Open Appendectomy. The study reveals that patient outcomes differ significantly between government facilities and private hospitals pointing to a need for common operating standards. The study establishes that surgical methods should adapt to match patient characteristics along with facility operational capabilities.

Optimizing Maternal Healthcare Access: A Mixed Method Study on Dual Utilization of Public and Private Antenatal Care Services in Puducherry, India

Abstract Background: Access to antenatal care (ANC) services has improved. However, it is also noted that some antenatal women seek multiple healthcare services. Exploring this practice will identify gaps in service provision and pave the path toward improving the quality of services. Objective: This study aimed to measure the concurrent use of public and private healthcare services for various components of ANC and understand the reasons for the dual utilization. Methodology: This explanatory mixed-method study enrolled 177 mothers residing in Puducherry, who had given birth in the last three years. A pretested, semi-structured questionnaire was administered, and six key informant interviews were conducted. Integration was performed in the interpretation stage, and a joint display was used to depict the results. We adopted the Donabedian model during the analysis and organized the codes under these major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Result: Most pregnant women (81.9%, 95% CI = 75.2%–86.8%) sought care from both public and private healthcare facilities, however, they preferred public facilities for delivery (74.6%, 95% CI = 67.6%–80.4%). The qualitative analysis revealed three major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Primary reasons for opting for private facilities included perceived superior ANC quality, organized care evident in scheduled appointments, reduced waiting time, frequent ultrasounds, personalized medication, and enhanced rapport with family. Women also believed that visits to government facilities are essential to avail the monetary benefits and have a seamless admission during delivery. They felt that government hospitals perform fewer cesarean sections. Conclusion: Strengthening public-private partnerships could enhance antenatal care utilization, benefiting pregnant women and streamlining healthcare delivery.

Knowledge and Practice of TB Notification among the Private Health Care Providers in Eastern India

Abstract Tuberculosis (TB) has been a notifiable disease since 2012. The study aimed to assess the knowledge and practice of private health care providers (PHCPs) regarding TB notification and to identify the physician-level and health system-level factors determining knowledge and practice of TB notification. A cross-sectional study was done in the field practice area of AIIMS Bhubaneswar. The study was conducted from February 2020 to May 2021 in Odisha. PHCPs from all systems of medicine were included in the study. The sample size was calculated to be 138. A self-administered semistructured questionnaire was used to collect the data. Multivariable logistic regression was done to identify the association between the independent and dependent variables. A total of 89 PHCPs were recruited into the study. Among them, 57 (64%) of the PHCPs were aware of TB notification, whereas 24 (42%) had ever notified a case of TB. All PHCPs who had ever diagnosed or treated a TB case were aware of TB notification. The factors associated with TB notification were the clinical setting of practice, diagnosed more than one TB case in the past 1 year, and those who worked in the government setting in the past 2 years. The knowledge and practice of TB notification were low among PHCPs. More frequent and mandatory sensitization training should be conducted for all PHCPs to increase awareness about TB notification.

Contextualizing guidelines for the health system of Cyprus: Experiences and lessons learnt

AbstractBackgroundCyprus is undergoing a major health reform with the recent establishment of the General Healthcare System (GHS). The GHS offers equal healthcare access through one primary insurer (Health Insurance Organization [HIO]) and benefits from a wide collaborative network of public and private healthcare providers. However, unwanted variation in practice makes this transition challenging. Healthcare guidelines could decrease these variations in practice, but Cyprus lacks the capacity to develop them de novo. Through a collaboration with the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the contextualization of NICE guidelines and the derivation of local quality indicators are carried out. This study presents the methodology and experience of contextualizing the first three NICE guidelines and deriving associated quality indicators in Cyprus.MethodsHIO managed the guideline contextualization with the support of a Guidelines Secretariat. For each guideline, a local topic expert committee (TEC) was recruited. Through a series of meetings, followed by public consultation, each TEC made contextual changes to the guideline and derived relevant quality indicators. During this process, NICE assured quality by overseeing several elements of the contextualization procedure such as TEC membership, proposed changes and justification and derived quality indicators.ResultsBetween 2022 and 2024, three NICE guidelines, NG196 on Atrial fibrillation (AF), NG230 on Thyroid cancer (TC) and NG203 on Chronic kidney disease (CKD), were contextualized through the modification of several individual guideline recommendations (21/79 [26.6%] in AF, 37/67 [55.2%] in TC and 62/217 [28.6%] in CKD). In parallel, NICE quality indicators were screened for applicability and feasibility in Cyprus while additional indicators were developed if required.ConclusionIn a country with limited experience in guideline development, a supervised and systematic process supported by an established organization ensures quality, is less resource intensive and builds capability for the sustainability of the process.

How value perspectives influence decision-making in the South African private healthcare sector: A cross-sectional comparative study.

Every healthcare clinical event aims to create value at a certain cost. This value has been defined as the outcome achieved (the degree to which a care event achieved a clinical goal) divided by the cost incurred (determined by the combined price charged by the care provides) to generate the outcome. Subsequently, patient experience has been included as a third factor contributing to value of care, but its value and relationship relative to clinical outcome and event cost is not well understood. This cross-sectional comparative study explored the relative importance of 1) clinical outcome, 2) event cost, and 3) patient experience as they relate to the value of care in the South African private healthcare context. Using a value perspectives survey, healthcare consumers (n = 662) and healthcare providers (n = 318) distributed 100 points between the three factors according to how they perceived their value. They were then asked to assess the value of the three factors across six clinical scenarios progressing in clinical severity. For all scenarios, all participants valued patient experience above event cost, but lower than clinical outcome. However, there were significant differences between consumers and providers in the relative value assigned to each of the three factors. These values changed as the severity of the surgical and medical scenarios changed. Patient experience was consistently assigned a higher value than event cost, thereby making a strong argument for its inclusion into the healthcare value equation. Both South African healthcare consumers and providers assigned significant value to patient experience across a range of clinical scenarios. These findings suggest that patient experience should be included as a factor in the Value Care Index (VCI) where VCI = (Outcome ÷ Cost) x Patient Experience.

Physician Perspectives on Factors That Influence Patients’ Choice Between the NHS and Private Healthcare: A Qualitative Study

Physician Perspectives on Factors That Influence Patients’ Choice Between the NHS and Private Healthcare: A Qualitative Study

Epidemiological characteristics of gastric and pancreatic cancers in Latin America: GASPAR (LACOG 0222) study.

369 Background: Gastric (GC) and pancreatic cancer (PC) have poor prognosis representing major public health challenges, particularly in Latin America. Real-world data are limited. GASPAR (LACOG 0222) study addresses this gap by creating a multicenter database to analyze epidemiological, clinical, and pathological data, treatments, and outcomes for patients (pts) with GC and PC. Methods: This retrospective and prospective observational cohort study enrolled pts from 7 research sites in 3 LATAM countries with metastatic/locally advanced not amenable to curative intent GC (Cohort A) and PC (Cohort B) diagnosed from January 2019. Data were collected from medical records. ( NCT05924789 ). Results: 201 pts were included: 122 with GC (Cohort A) and 79 with PC (Cohort B). 150 (75%) from Brazil, 29 (14%) from Argentina, and 22 (11%) from Colombia. Median age at diagnosis was 69 years (IQR 57-78), 70 (35%) had history of tobacco use, and 153 (76%) were covered by private healthcare (Table). In Cohort A (GC), HER2 status was assessed in 105 (86%) pts, with 12 (11%) HER2-positive; PD-L1 was tested in 87 (71%): 55 (63%) had ≥1% expression and 28% had ≥10%; all 88 (72%) patients who had MMR tested had MMR proficient. First-line treatment was given to 107 (88%) pts: 78 (73%) chemotherapy (CT) alone (FOLFOX in 43 [40%]; FLOT in 16 [15%]); 23 (21%) CT + immunotherapy; and 7 (7%) CT + anti-HER2. Only 59 (48%) pts received second-line treatment and 31 (25%) third-line. With median follow-up (mFUP) of 29 months (CI95% 18.2-50.4), the median progression-free survival (mPFS) at first-line was 5.6 months (CI95% 4.2-6.3) and the median overall survival (mOS) was 11.2 months (CI95% 9.2-14.1). In Cohort B (PC), 67 (85%) pts received first-line treatment: 41 (61%) FOLFIRINOX and 14 (21%) gemcitabine-nab-paclitaxel. 27 (34%) pts received second-line treatment and 10 (13%) third-line. With mFUP of 21 months (CI95% 15.6-NR), the mPFS at first-line was 5.4 months (CI95%3.9-6.4) and the mOS was 10.2 months (CI95% 8.6-13.1). Conclusions: The GASPAR study provides valuable real-world data on GC and PC in Latin America. Notably, the mPFS in both cohorts was slightly lower than historical controls for first-line treatments, while the mOS was similar, suggesting earlier disease progression despite comparable overall survival. Improved therapeutic strategies and healthcare access are needed to enhance outcomes for these populations. Clinical trial information: NCT05924789 . Clinical characteristics. Characteristic GC (Cohort A)N=122 PC (Cohort B)N=79 Median age (IQR), yr 66 (51–78) 71.0 (61–79) Male – n. (%) 58 (56) 40 (51) Race – n. (%) White 67 (55) 71 (90) American Indian or Alaska Native 15 (12) 6 (8) Black 7 (6) 0 Other 7 (6) 0 Not reported 26 (21) 2 (2) Disease status at study entry Locally advanced disease 4 (3) 14 (18) Metastatic disease 118 (97) 65 (82) ECOG status in first-line advanced disease – n. (%) 0-1 75 (70) 45 (67) ≥ 2 13 (12) 3 (4.5) Not reported 19 (17.8) 19 (28.4)

Clostridioides difficile hypervirulent strain ST1 isolated from clinical stool specimens obtained from three Provinces in South Africa

Clostridioides difficile infection is a serious healthcare-associated infection linked to antimicrobial use. The severity of the disease can be associated with hypervirulent ribotypes such as RT027. The study aimed to investigate the molecular epidemiology and genomic characteristics of C. difficile isolates from private and public healthcare settings in South Africa. One hundred clinical stool specimens were cultured on cycloserine-cefoxitin-fructose agar. Conventional multiplex polymerase chain reaction (M-PCR) assays were conducted for isolate identification and detection of toxin genes. Genomic characteristics of the isolates were determined using whole genome sequencing (WGS) and data was analysed using pubMLST, EnteroBase, Pathogenwatch and CARD. One hundred clinically presumptive C. difficile positive stool specimens were collected, of which 62% (62/100) were confirmed as C. difficile by M-PCR assay. Among the 62 identified C. difficile isolates, 97% (60/62) were toxigenic, with the most dominant toxin profile being A+B+CDT+according to the M-PCR assay. The results showed that 93% (40/43) of the WGS analysed C. difficile strains clustered into clades 1 to 5. These 40 strains were categorized into 16 sequence types (STs), with ST1 (clade 2) being the most prevalent, representing 45% (18/40), this strain is an RT027-associated strain previously epidemic hypervirulent strain. One major cluster (n=18) comprising ST1 strains was identified in Gauteng Province and all the isolates associated with this cluster showed the same resistome (antimicrobial resistance genes and mutations: CDD-1, aac (6')-Ie-aph (2″)-Ia, PnimBG and Thr82Ile). The study also identified one strain as ST11, this strain is well known for its zoonotic potential, and two strains were identified as ST37 known as an epidemic strain. Strains from public healthcare settings exhibited genetic similarity, while those from private settings showed greater genetic diversity. The study reported, for the first time, hypervirulent strains ST1 in Africa and ST11 in South Africa, with a minimum spanning tree indicating an ongoing ST1 outbreak.

COVID-19 policies and tuberculosis services in private health sectors of India, Indonesia, and Nigeria

The COVID-19 pandemic created unprecedented challenges in the field of global health. Nigeria, Indonesia and India are three high tuberculosis (TB) burden countries with large private health sectors. Both TB and the private health sector faced challenges in these countries because of COVID-19. This study aimed to compare the COVID-19 control measures and policies in the provision of TB care services and gain insights from policymakers on how the pandemic affected the provision of TB services in the private healthcare sector, how each country adapted, and identify lessons learned for health system preparedness. Qualitative, in-depth interviews were conducted among a purposive sample of 11 national and sub-national policymakers in each country. Thematic content analysis was conducted on the data collected using an adapted WHO Health Equity Policy Framework. Results revealed three policy dimensions under costs, access, and quality. Under healthcare costs, policymakers highlighted resource allocation and diversion of TB resources to COVID response, and increased operational costs for private provider. Under healthcare access, key themes included reduced TB case detection due to fear of COVID-19, disrupted diagnostic services, and adaptations such as extended medicine supplies and tele-consultations. Under healthcare quality, themes included compromised TB diagnostic accuracy due to similar respiratory symptoms with COVID-19, and strain on laboratory infrastructure due to competing demands from both diseases. Policymakers across the three countries pointed to the need for strengthening private-public partnerships (PPP) for healthcare service delivery and continued private sector investment to facilitate the continuity of TB care within a pandemic context. The results of this study provide an overview of the impact of the pandemic from the perspective of private facilities and policymakers in Nigeria, Indonesia and India, which can inform future policy and ways forward in strengthening PPP for healthcare service delivery in high TB burden countries.

Comment on 'COVID-19 vaccine wastage in private and public healthcare facilities in KwaZulu-Natal, South Africa'.

Comment on 'COVID-19 vaccine wastage in private and public healthcare facilities in KwaZulu-Natal, South Africa'.

A Political Economy Analysis of Health Policymaking in Nigeria: The Genesis of the 2014 National Health Act.

This article explores the ideologies, interests, and institutions affecting health policymaking in Nigeria, and the role of the private sector therein. It covers the period from the late-1950s, the years leading up to independence, to 2014, when the country enacted its first-ever law to govern its healthcare system. The National Health Act (NHAct) was adopted after a decade of preparation and civil society-driven advocacy, making the objective of Universal Health Coverage (UHC) explicit. However, in its final version, the NHAct earmarked only a small share of public funds for UHC, solidifying the country's reliance on private healthcare and out-of-pocket payments. To examine the specific set of ideologies, interests, and institutions defining Nigeria's pathway toward UHC and the contribution of the private sector, we adopted Rizvi and colleagues' political economy framework, situating the genesis of the 2014 NHAct within the broader political and economic context of Nigeria's health system reform process since the 1950s. Drawing on qualitative data collected during interviews and focus groups, we found that the deep entrenchment of private-sector healthcare in Nigeria is the result of a path-dependent process. This implies that Nigeria's current reliance on the private sector is influenced by historical patterns, competing interests, and institutional practices that have reinforced the role of private actors over time. We identified three major explanatory factors that have shaped health policymaking in Nigeria. First, since the 1980s, the ideology that private healthcare is the solution to an underfunded and underperforming public healthcare system has been reinforced by leading international organisations. Second, private actors in Nigeria have been in a strong position to influence health policymaking since independence. Third, Nigeria's challenging socioeconomic context and the limitations of its federal governance structure have fostered a general level of public distrust in the capacity of the public sector to provide quality healthcare.

A study on Evaluation of Patient Satisfaction with National Tuberculosis Elimination Programme Services in Ahmedabad, India

Abstract Background: India accounts for the highest burden of tuberculosis cases in the world. Patient satisfaction is a key criterion for evaluating the quality of healthcare services as satisfaction has been found to be associated with superior compliance and better outcomes. Study was planned with the objectives to assess the patient’s satisfaction regarding treatment-related services under NTEP. Materials and Methods: Community-based cross-sectional study was carried out at Ahmedabad Municipal Corporation (AMC) Area. A total of 200 participants were included in the study from various zones of AMC. Probability-proportional-to-size sampling was done and patients seeking care at public (126; 63%) and private (74; 37%) healthcare facilities were included. Questionnaire contained questions related to general sociodemographic profile of participants and satisfaction to NTEP service for which, PSQ-18 Questionnaire was utilized. Results: Overall satisfaction to NTEP services was found to be 86%. Amongst public healthcare facilities satisfaction was found to be 86.5% whereas in private healthcare facility it was 85.1%. Compliance to TB treatment was found in 91.5% of participants. Domains such as general satisfaction, communication, time spent with doctors, and accessibility and convenience were found to be statistically significant at private facility compared with public healthcare facility. Conclusion: Statistically significant difference was found between patient satisfaction at public and private health facilities in domains of general satisfaction, communication, time spent with doctor, and accessibility and convenience. The same domains at public and private type of healthcare facilities were found to have statistically significant role in treatment compliance by study participants.

Empowering healthcare: the link of self-efficacy, employee engagement, and citizenship behaviors

Purpose This study investigates employee engagement within private healthcare settings, with a particular emphasis on the connection between occupational self-efficacy and organizational citizenship behaviors. Design/methodology/approach A mixed-methods approach was utilized for this research. Interviews were conducted with employees across different managerial levels to identify various employee engagement strategies implemented in eight private hospitals in West Bengal. Subsequently, a survey of 414 healthcare employees from these institutions was conducted using a structured questionnaire. The study employed Confirmatory Factor Analysis, linear regression, and mediation analysis using the Sobel test to explore the relationships between variables. Findings The study revealed a significant positive correlation among all variables. Employee engagement was identified as a mediating factor between occupational self-efficacy and organizational citizenship behavior. Research limitations/implications This research is focused exclusively on the healthcare sector, with no data collected from other sectors, which may limit the generalizability of the findings. The sample size and geographic scope were restricted, which may not capture the full diversity of perspectives within the healthcare sector. Practical implications This research indicates that OSE promotes OCB, with this effect amplified when mediated by EE. Thus, fostering EE can significantly contribute to achieving OCB, a crucial factor in the healthcare sector. Given these insights, public healthcare institutions, which often serve a larger and more diverse patient population, could benefit from adopting similar engagement-enhancing practices. In these high-pressure environments, where employees frequently need to exceed their formal role definitions, cultivating a culture of engagement becomes paramount. By implementing targeted EE initiatives, government hospitals can potentially improve OCB among their staff, leading to enhanced patient care and operational efficiency. Government healthcare HR professionals can enhance OSE through training, coaching, and talent recognition programs. Empowering employees via skill development and participative decision-making can boost OSE and its positive impact on OCB. Originality/value This study offers novel insights that can inform practices in both private and public healthcare sectors, representing a pioneering effort in the Indian context. By examining these dynamics, the research aims to contribute to the development of strategies that enhance employee engagement, ultimately leading to improved patient care that goes beyond standard job descriptions.

A PRIVATIZAÇÃO DA ATENÇÃO PRIMÁRIA À SAÚDE NO BRASIL: CONSIDERAÇÕES SOBRE OS ATAQUES AO SISTEMA ÚNICO DE SAÚDE

This article investigates the impacts of the privatization of Primary Health Care (PHC) in Brazil and its implications for the Unified Health System (SUS). Starting from the contextualization provided by the Federal Constitution of 1988, which recognizes health as a right for all and a duty of the State, the study focuses on the subsequent administrative reforms that have influenced the management of public health in the country, with special emphasis on PHC. The main objective is to assess both the potential benefits and the risks and challenges associated with the privatization of PHC within the context of the SUS. The methodology employed consists of a systematic review of recent literature, covering studies published between 2018 and 2024, with a focus on the practices and policies of PHC privatization. The results indicate that, despite promises of greater efficiency and innovation, privatization has led to negative impacts on service quality, shifting the focus from user well-being to profit. It concludes that, although the privatization of PHC may seem beneficial in theory, in practice, it tends to compromise the principles of equity and universality of the SUS, requiring a reevaluation of public policies involving private health management.

Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden

AimsTo study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).MethodsWe used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.ResultsIn total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24–2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06–1.29), physical activity 1.13 (1.06–1.17), unhealthy diet 1.08 (1.04–1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09–1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.ConclusionsThese findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

P1078 Weight-loss medications and bariatric surgery are infrequently used in obese patients with inflammatory bowel disease in North and East Devon in the United Kingdom (UK)

Abstract Background Obesity is increasingly prevalent in patients with IBD and has been linked to non-response to medical therapies and disease progression. In the last decade the management of obesity in the general population has undergone a paradigm shift following the widespread use of medical therapies and bariatric surgery. Few studies have assessed weight loss strategies used by obese patients with IBD. Methods We designed a Patient and Public Involvement and Engagement survey to assess past use and future interest in interventions for obesity. We also sought interest in a trial of a licensed weight loss medication as an adjunct to conventional IBD therapy. We used the MyChart application in our electronic patient record (EPIC) to distribute our questionnaire between 6th and 18th November 2024. The response rate was 31% (828/2700): 40.0% [322/828], 52.9% [426/828], 7.1% [57/828] patients were diagnosed with Crohn’s disease, UC and IBDU, respectively. Body mass indices were available in 97% (807/828) patients. Results The median [IQR] age was 54.0 (41.0 - 65.0) years, 58.5% (484/828) were female and 92.8% [768/828] were of white European ancestry. Overall, 29.0% (234/807) were overweight and 25.0% (202/807) were obese. 30.7% (254/828) were eligible for a medication for weight management, by having a BMI ≥30 kg/m2 or a BMI ≥27 kg/m2 in addition to one or more weight-related comorbidity. Amongst these patients prior experience with weight loss strategies included: 51.6% (131/254) self-directed dieting; 33.9% (86/254) calorie counting using a smartphone app; 38.2% (97/254) had attended a weight-loss group; 16.1% (41/254) had had advice from a dietician; 2.8% (7/254) had taken part in a formal exercise program; 5.9% (15/254) had used weight loss medications [6 orlistat, 14 GLP-1 agonist] and 1.6% (4/254) had had bariatric surgery. Of 14 patients treated with a GLP-1 agonist, 5 and 9 were prescribed by public and private healthcare professionals respectively. Amongst patients eligible for pharmacological treatment: 11.4% (29/254) expressed interest in future group-based support; 30.8% (78/254) in a formal exercise program; 37.4% (95/254) advice from a dietitian; 43.3% (110/254) drug treatment and 11.4% (29/254) endoscopic or surgical weight loss procedures. 72.8% (185/254) of patients expressed interest in participating in a trial of a licensed weight loss medication as an adjunct to conventional IBD treatment. Conclusion Obese patients living with IBD want access to weight loss interventions. However, previous use of weight loss medications was uncommon and usually accessed through private healthcare. Three quarters of obese patients expressed an interest in a trial of a licensed weight loss medication as an adjunct to conventional IBD therapy.

P1038 Establishing a Tertiary-Level Inflammatory Bowel Disease Service in the UAE: A Response to Rising Incidence and Service Gaps

Abstract Background Inflammatory bowel disease (IBD) is a growing public health concern in the Middle East, with the UAE experiencing a rapid rise in its incidence. Due to the predominance of private healthcare facilities, dedicated IBD services are exceedingly rare, and care is often fragmented. We outline the key initiatives undertaken to establish one of the few structured and comprehensive IBD services in the region. Methods Post-2023, our hospital initiated targeted changes to establish a tertiary care IBD service in the UAE. Through an analysis of service modifications and organizational strategies, we detail efforts to improve care delivery towards providing excellence in IBD care. Results The introduction of a structured care model has significantly improved IBD outcomes through a dedicated team of IBD-trained physicians, IBD clinical nurse specialist (CNS), and an administrator. Multidisciplinary meetings have standardized care, enabling early diagnosis, initiation and optimisation of advanced therapies (AT). The service has notably reduced corticosteroid use, indicating effective disease control. A growing comprehensive IBD registry now prospectively tracks over 320 patients on AT, providing valuable data for clinical and research needs. High-risk patient lists and virtual flare clinics have decreased hospital admissions by nearly 90%, facilitating proactive management. The service has early adoption of novel ATs and is supported by an active clinical trials program. Early initiation of AT, particularly for moderate to severe Crohn’s disease, has reduced the median time to treatment from diagnosis to 1.54 months (IQR 2.23) in 2024. Holistic IBD clinics, with access to a specialist dietitian and psychologist, have improved patient satisfaction and outcomes. CNS-led initiatives, including educational sessions on medication use, disease management, preconception and pregnancy care have significantly boosted patient engagement and health outcomes. Patient support and advocacy groups have been established, providing a platform for education and shared experiences. Additionally, Arabic versions of disease and AT patient information leaflets have been developed to enhance accessibility and understanding. Advanced IBD endoscopy, including chromoendoscopy, is now offered as standard care. Conclusion The establishment of a structured, multidisciplinary IBD service has transformed care delivery, addressing critical gaps in the regional healthcare landscape. Key initiatives have led to improved clinical outcomes, reduced hospital admissions, and enhanced patient satisfaction. This model serves as a benchmark for comprehensive IBD care in the region, demonstrating the impact of specialized, patient-centred services.

95-95-95 HIV indicators among children younger than 15 years in South Africa: results from the 2017 national HIV prevalence, incidence, behaviour, and communication survey

BackgroundEarly detection and initiation of care is crucial to the survival and long-term well-being of children living with HIV (CLHIV). However, there remain challenges regarding early testing and linking of CLHIV for early treatment. This study examines the progress made towards achieving the 95-95-95 HIV indicators and associated factors among CLHIV < 15 years in South Africa.MethodsThe data was collected as part of the 2017 cross-sectional, multistage cluster randomized population-based household National HIV survey. Age-appropriate structured questionnaires were utilized to gather sociodemographic data, HIV-related knowledge, risk behaviours, and health-related information. Blood samples were collected to test for HIV serology, viral load suppression, and antiretroviral usage. Backward stepwise multivariable generalized linear regression models were fitted to identify factors associated with the 95-95-95 HIV indicators. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are shown, and p < 0.05 indicates statistical significance.ResultsA total of 12,237 CLHIV < 15 years were included (median 8 years, interquartile range 4–11 years). HIV prevalence was 2.8% (95% CI: 2.4–3.3). Overall, 40.0% of the CLHIV were tested and knew their status (first 95%), and among these, 72.6% (95% CI: 61.7–81.3) were on antiretroviral therapy (ART) (second 95%), and 95.0% (95% CI: 88.4–97.9) of these were virally suppressed (third 95%). Among CLHIV, the odds of testing and knowing the HIV-positive status were significantly higher among children whose health was rated as fair/poor than excellent/good [AOR = 1.32 (95%CI: 1.05–1.67), p = 0.022], and were significantly lower among females than males [AOR = 0.82 (95% CI: 0.71–0.95), p = 0.009], and were significantly lower among those attending private healthcare facilities than public health facilities [AOR = 0.64 (95% CI:0.57–0.74), p < 0.001]. Among those who knew their HIV-positive status, the odds of being on ART were significantly higher among children residing in farm areas than urban areas [AOR = 1.40 (95% CI:1.05–1.86), p = 0.017], and were significantly lower among children attending private healthcare facilities [AOR = 0.44 (95% CI:0.36–0.54), p < 0.001].ConclusionsAwareness of HIV status and initiation of treatment in children was low. The findings highlight the need to improve HIV status awareness and disclosure to children. The findings underscore the need for targeted interventions and programs tailored for CLHIV in urban areas.

Multimodal machine learning for analysing multifactorial causes of disease-The case of childhood overweight and obesity in Mexico.

Mexico has one of the highest global incidences of paediatric overweight and obesity. Public health interventions have shown only moderate success, possibly from relying on knowledge extracted using limited types of statistical data analysis methods. To explore if multimodal machine learning can enhance identifying predictive features from obesogenic environments and investigating complex disease or social patterns, using the Mexican National Health and Nutrition Survey. We grouped features into five data modalities corresponding to paediatric population exogenous factors, in two multimodal machine learning pipelines, against a unimodal early fusion baseline. The supervised pipeline employed four methods: Linear classifier with Elastic Net regularisation, k-Nearest Neighbour, Decision Tree, and Random Forest. The unsupervised pipeline used traditional methods with k-Means and hierarchical clustering, with the optimal number of clusters calculated to be k = 2. The decision tree classifier in the supervised early fusion approach produced the best quantitative results. The top five most important features for classifying child or adolescent health were measures of an adult in the household, selected at random: BMI, obesity diagnosis, being single, seeking care at private healthcare, and having paid TV in the home. Unsupervised learning approaches varied in the optimal number of clusters but agreed on the importance of home environment features when analysing inter-cluster patterns. Main findings from this study differed from previous studies using only traditional statistical methods on the same database. Notably, the BMI of a randomised adult within the household emerged as the most important feature, rather than maternal BMI, as reported in previous literature where unwanted cultural bias went undetected. Our general conclusion is that multimodal machine learning is a promising approach for comprehensively analysing obesogenic environments. The modalities allowed for a multimodal approach designed to critically analyse data signal strength and reveal sources of unwanted bias. In particular, it may aid in developing more effective public health policies to address the ongoing paediatric obesity epidemic in Mexico.

Strengthening Public Child Healthcare: Development of an Immunization Management Information System for a Local Community in Southern Mindanao, Philippines

While the private healthcare sector rapidly embraces technological advancements, public and local communities struggle to keep pace with these innovations. Community health personnel's reliance on outdated manual methods for managing children's immunization records hinders timely updates and impedes the creation of reliable vaccination schedules, creating obstacles in providing accurate services to the growing young population. To address these challenges, the researchers developed an Immunization Management Information System, employing the Evolutionary Prototyping Software Development Model, which allowed for iterative improvements and customization to meet specific requirements. It incorporates technologies such as a centralized database, a web-based interface, and Short Message Service notification functionality to automate immunization management tasks. Healthcare professionals can record and track immunization details, manage vaccine inventory, generate reports, and send notifications to parents about upcoming immunization schedules. The results demonstrated a system that streamlines and enhances the management of immunization records and processes at the health center, ensuring efficient and timely delivery of services. Discussions on the system's technological features and future research directions are provided, encouraging Information System scholars to contribute to impactful research and development.