Health Service Providers Research Articles

Impact of the COVID-19 pandemic on health-care use among patients with cancer in England, UK: a comprehensive phase-by-phase time-series analysis across attendance types for 38 cancers

The COVID-19 pandemic resulted in the widespread disruption of cancer health provision services across the entirety of the cancer care pathway in the UK, from screening to treatment. The potential long-term health implications, including increased mortality for individuals who missed diagnoses or appointments, are concerning. However, the precise impact of lockdown policies on national cancer health service provision across diagnostic groups is understudied. We aimed to systematically evaluate changes in patterns of attendance for groups of individuals diagnosed with cancer, including the changes in attendance volume and consultation rates, stratified by both time-based exposures and by patient-based exposures and to better understand the impact of such changes on cancer-specific mortality. In this retrospective, cross-sectional, phase-by-phase time-series analysis, by using primary care records linked to hospitals and the death registry from Jan 1, 1998, to June 17, 2021, we conducted descriptive analyses to quantify attendance changes for groups stratified by patient-based exposures (Index of Multiple Deprivation, ethnicity, age, comorbidity count, practice region, diagnosis time, and cancer subtype) across different phases of the COVID-19 pandemic in England, UK. In this study, we defined the phases of the COVID-19 pandemic as: pre-pandemic period (Jan 1, 2018, to March 22, 2020), lockdown 1 (March 23 to June 21, 2020), minimal restrictions (June 22 to Sept 20, 2020), lockdown 2 (Sept 21, 2020, to Jan 3, 2021), lockdown 3 (Jan 4 to March 21, 2021), and lockdown restrictions lifted (March 22 to March 31, 2021). In the analyses we examined changes in both attendance volume and consultation rate. We further compared changes in attendance trends to cancer-specific mortality trends. Finally, we conducted an interrupted time-series analysis with the lockdown on March 23, 2020, as the intervention point using an autoregressive integrated moving average model. From 561 611 eligible individuals, 7 964 685 attendances were recorded. During the first lockdown, the median attendance volume decreased (-35·30% [IQR -36·10 to -34·25]) compared with the preceding pre-pandemic period, followed by a median change of 4·38% (2·66 to 5·15) during minimal restrictions. More drastic reductions in attendance volume were seen in the second (-48·71% [-49·54 to -48·26]) and third (-71·62% [-72·23 to -70·97]) lockdowns. These reductions were followed by a 4·48% (3·45 to 7·10) increase in attendance when lockdown restrictions were lifted. The median consultation rate change during the first lockdown was 31·32% (25·10 to 33·60), followed by a median change of -0·25% (-1·38 to 1·68) during minimal restrictions. The median consultation rate decreased in the second (-33·89% [-34·64 to -33·18]) and third (-4·98% [-5·71 to -4·00]) lockdowns, followed by a 416·16% increase (409·77 to 429·77) upon lifting of lockdown restrictions. Notably, across many weeks, a year-over-year decrease in weekly attendances corresponded with a year-over-year increase in cancer-specific mortality. Overall, the pandemic period revealed a statistically significant reduction in attendances for patients with cancer (lockdown 1 -24 070·19 attendances, p<0·0001; minimal restrictions -19 194·89 attendances, p<0·0001; lockdown 2 -31 311·28 attendances, p<0·0001; lockdown 3 -43 843·38 attendances, p<0·0001; and lockdown restrictions lifted -56 260·50 attendances, p<0·0001) compared with before the pandemic. The UK's COVID-19 pandemic lockdown affected cancer health service access negatively. Many groups of individuals with cancer had declines in attendance volume and consultation rate across the phases of the pandemic. A decrease in attendances might lead to delays in cancer diagnoses, treatment, and follow-up, putting such groups of individuals at higher risk of negative health outcomes, such as cancer-specific mortality. We discuss the factors potentially responsible for explaining changes in service provision trends and provide insight to help inform clinical follow-up for groups of individuals at risk, alongside potential future policy changes in the care of such patients. Wellcome Trust, National Institute for Health Research University College London Hospitals Biomedical Research Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Academy of Medical Sciences, and the University College London Overseas Research Scholarship.

Ten-year outcomes of a prospective population-based incidence cohort of inflammatory bowel disease patients from Canterbury, New Zealand.

Inflammatory bowel disease (IBD) is a progressive condition where ongoing inflammation in the gastrointestinal tract can lead to complications such as strictures, and fistulae. The long-term outcomes of newly diagnosed patients under current medical therapy can be used to plan health service provision and guide patients. Prospective population-based data on all incident patients diagnosed with IBD in Canterbury was gathered in 2014 (n = 205). The medical records of these patients were followed for medication use, disease progression, hospitalization, surgery and mortality, in the 10 years since their diagnosis. Survival analysis and cox regression determined characteristics associated with earlier time to these outcomes. Medical records of 184 IBD patients were able to be retrieved. Immunomodulators were used by 62% and biologics by 35%; hospitalization occurred for 42% and surgery for 15%. Montreal phenotype progression occurred for 21 and 7% of the cohort died. Younger age at diagnosis hazard ratio (HR) 2.1 (95% confidence interval [CI] 1.1-4.0) and Crohn's disease HR 1.7 (95% CI 1.1-2.6) was associated with immunomodulator use. Younger age was also associated with biologic use HR 2.9 (95% CI 1.2-6.9). Male gender was associated with surgery HR 2.8 (95% CI 1.2-6.4). Perianal disease at diagnosis (14.7%) was associated with immunomodulator use HR 2.58 (95% CI 1.44-4.59) and Montreal phenotype progression HR 2.93 (95% CI 1.10-7.77). In the 10 years since diagnosis disease progression and treatment escalation occurred for most of this population-based cohort. Earlier intervention for patients with higher-risk characteristics may improve long-term outcomes reducing the burden on health systems.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study.

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

Public awareness, attitudes, behavior and norms building green hospitals' power

Hospitals function to provide health services to the community, but they have the potential to be contributors to hazardous waste, climate change, and global warming. The concept of green hospitals is now necessary for changing hospital functions developed by various hospitals worldwide. The success of the green hospital concept requires support from the perspective of the surrounding society. The research aims to analyze public awareness, attitudes, behavior, and norms to build the power of green hospitals. This research method is simple linear regression. The research instrument used a questionnaire. The respondents of this research were 400 green hospital users from Indonesia and Taiwan. The data analysis method includes tests for normality, linearity, and heteroscedasticity. Once these three tests are met, a linear regression analysis is conducted to understand the influence and prediction of public awareness, attitudes, behavior, and norms on building the power of green hospitals. The research results show that each aspect of public awareness, attitudes, behavior, and norms significantly positively influence the building of the power of green hospitals. Each additional value of public awareness, attitudes, behavior, and norms is expected to strengthen the image of a green hospital. Maintaining the sustainability of green hospital programs worldwide not only focuses on implementing the green concept but also needs to pay attention to public perception when choosing a hospital. The research contribution is significant to developing more sustainable green hospitals, increasing knowledge about green hospitals, and increasing public interest and perception of green hospitals.

Impact of Picky Eating Behavior on Nutritional Status in Toddlers Aged 24-59 Months Using Weight and Height Measurements at Bone Health Center, Muna Regency

Introduction: One of the Health Centers in Muna Regency, namely Bone Health Center, has 1.6% very thin toddlers, 7.4% thin toddlers, 0.5% very short toddlers, 5.7% short toddlers, 6.4% malnourished toddlers, 8.7% undernourished toddlers, 0.2% obese toddlers. Eating problems in children, one of which is picky eating which is a factor influencing the nutritional status of children. Generally, in children who behave picky, or choose food, there will be inadequacy of food intake. Based on this background, researchers are interested in conducting research on the relationship between picky eating behavior and nutritional status in toddlers aged 24-59 years based on Weight/Height at the Bone Health Center, Muna Regency Method: Using quantitative research methods with a cross-sectional approach, the population was 566 and the sample was 228 toddlers aged 24-59 months using the Lameshow formula in determining the sample. Data collection by interview using a questionnaire. Result: X2 count is .468 &lt; X2 table is 3.841, so there is no relationship between picky eating and nutritional status based on Weight/Height in the Bone Health Center area, Muna Regency. Conclusion: The Health Center as a health service provider should increase outreach to the community and maximize monitoring and improvement of nutrition together with parents of toddlers, especially in the Bone Health Center area.

Unusual Lifespan of Edwards' Syndrome in COVID-19 Era

Edwards' syndrome is caused by an extra chromosome on the 18th chromosome. Patients with this diagnosis have median survival of only 3-14.5 days, with the majority of infants with full trisomy 18 type die before or shortly after they are born. There is only supportive treatment available for Edwards’ syndrome. During the COVID-19 pandemic, providing health services was challenging, leading to less than optimum treatments added by patients’ reluctance to visit healthcare facilities due to the fear of COVID-19 transmission. This case study presented an infant with Edwards’ syndrome with major malformation. The patient had several organ problems, was admitted to the NICU, and continued with home care for monitoring for 6 months. Patient then died at 9 months of age. Maintaining the best quality of life for this patient was very challenging for parents and healthcare providers. Since the management for this type of sydnome is more palliative, good education, information, and psychosocial supports for the parents are needed to prepare them with the worst conditions, which was especially more challenging during the COVID-19 pandemic.

Provision of prostate cancer services in Tanzania: perspectives from five tertiary hospitals

BackgroundAccess to quality prostate cancer services remains a global challenge, particularly in Low- and Middle-Income countries. This is often due to weak health systems that struggle to meet the population’s needs. The provision of quality health services to patients with prostate cancer requires a comprehensive approach involving multiple stakeholders and structural inputs. However, few studies have comprehensively assessed the relationship between these structural inputs and prostate cancer treatment outcomes. This study, therefore, aimed to determine the availability of selected structural inputs and descriptions of how they influence the provision of quality services to patients with prostate cancer in Tanzania.MethodsWe conducted a cross-sectional study using an explanatory sequential mixed-method approach to collect data from five tertiary hospitals providing cancer services in Tanzania. A validated checklist was used to collect information on available structural inputs for prostate services at tertiary hospitals. A semi-structured interview guide was used to conduct 42 in-depth interviews with 20 healthcare providers, five hospital managers, and 17 patients undergoing treatment for prostate cancer. Descriptive analysis was performed for the quantitative data, and thematic analysis was conducted with the aid of NVivo 14 qualitative software for the interview transcripts.ResultsAll five assessed tertiary hospitals had inadequate human resources for health to provide prostate cancer services. Only one had 70% of the required HRH, while none had above 40% of the required HRH. Within the hospitals, the skill mix imbalance was severe across cadres. Five themes emerged: inadequate infrastructure, delays in diagnosis, delays in treatment, shortage of human resources for health (HRH), and inefficient organization of prostate cancer services.ConclusionThe findings of this study, underscore the major health system deficiencies for the provision of prostate cancer services in tertiary hospitals. With the increased aging population, strong health systems are vital in addressing conditions of old aging, including prostate cancers. Studies on optimization of the available HRH and infrastructure are needed to improve the provision of prostate cancer in tertiary hospitals as an interim solution while long-term measures are needed for improving the HRH availability and conducive infrastructure.

Optimization of K-Means Clustering Method for Drug Grouping at Mertoyudan I Health Center, Magelang

Health centers as health service providers have an important role in ensuring adequate drug availability for the community. However, drug management in health centers often faces obstacles, including the use of manual methods in stock monitoring, which can lead to unavailability or accumulation of unused drugs. This study aims to improve the efficiency of drug management in health centers through the application of the K-Means Clustering method. This method is used to group drug stocks into three main clusters: heavy drugs, moderate drugs, and light drugs. With this grouping, it is expected that pharmacists can more easily determine the type of drug, monitor drug availability in a timely manner, and manage drug procurement according to patient needs. Research methods include literature studies, data collection and analysis, system modeling design, and system testing and evaluation. The results of this study are expected to improve the efficiency of drug management in health centers, so that health services to the community can be more optimal. The results of testing using the Silhouette Coefficient (SC) method produced an average SC of 0.97 which means strong structure, so it can be concluded that it has a strong structure.

Public-Private Partnership: An Effective Solution for Providing Health Services to the Elderly

Population aging has become a significant phenomenon in the 21st century due to rising life expectancy and declining fertility rates. The global elderly population, estimated at 727 million in 2020, is projected to double by 2050, with developing countries facing a greater proportion of elderly residents. This demographic shift will impact various sectors of society, including healthcare, leading to increased demand for medical services and higher costs. Public-Private Partnerships (PPP) are an effective mechanism to improve access to health services for the elderly, enhance service quality, and manage costs. It is crucial for policymakers to explore global experiences with PPP to develop strategies that address the unique economic and social conditions in Iran, ensuring an effective response to the rapid changes in healthcare needs for the aging population.

The role of the third sector in public health service provision: evidence from 25,338 heterogeneous procurement datasets

The role of the third sector in public health service provision: evidence from 25,338 heterogeneous procurement datasets

Factors Related to Compliance with HBsAg Screening Among Pregnant Mothers in Bengkulu Province

Background:The low number of Hepatitis B surface antigen (HBsAg) screenings indicates that the people of Bengkulu Province have a limited understanding of the importance of such examinations. In Bengkulu, 1.61% of pregnant women, or approximately 47.550 individuals, are positive for hepatitis B infection. This is partly due to the low rate of HBsAg screening among pregnant women. Objective:To determine the prevalence of HBsAg screening compliance among pregnant women and the factors influencing it. Method:This research utilized a cross-sectional study design. A multistage random sampling method was used to select 488 pregnant women from nine districts and one city in Bengkulu Province. Data analysis was performed using multiple logistic regression. Results:The findings showed a non-compliance rate for the HBsAg test of 77.87% (95% CI: 73.95-81.34). Factors associated with non-compliance included maternal perception (adjusted OR: 7.01, 95% CI: 3.62–13.57), quality of life (adjusted OR: 6.19, 95% CI: 2.98–12.88), husband's support (adjusted OR: 2.16, 95% CI: 1.11–4.18), and health worker support (adjusted OR: 3.68, 95% CI: 1.91–7.08). Conclusion:It is crucial for pregnant women to increase their awareness of the importance of HBsAg screening, supported by their husbands, with additional counseling on the negative impacts of hepatitis B during pregnancy. Cultural perceptions should be addressed to foster more positive attitudes. Enhanced collaboration between health service providers, traditional or community leaders, and the public is necessary to improve overall public health outcomes. Keywords: HBsAg screening compliance; health literacy; quality of life; perception; husband support; health worker support

The covid-19 pandemic and its effect on maternal health indicators in Latin American countries

Introduction: Maternal mortality constitutes one of the most important indicators of public health, and also reflects the response capacity of health systems to the healths needs of one of the most vulnerable groups, such a pregnant women. Objective: Conduct a bibliographic review of the maternal mortality indicators used by health management teams, before and during the COVID-19 pandemic in Latin American countries. Methodology: A bibliographic review was carried out by searching for scientific articles related to the topic. In addition, information was collected from epidemiological bulletins updated as of the review date. The PEO question was used (Population: pregnant women. Exposure: before and during the COVID-19 pandemic Result: maternal mortality in the context before and during the pandemic): What are the maternal mortality indicators before and during the COVID-19 pandemic? The search sources were PubMed, Scielo and Google Scholar. The key words were: "Maternal mortality" "Morbidity and mortality indicators" "COVID-19". Articles published from January 1, 2021 to May 30, 2023 were selected. Results: Of the 5670 articles found, 5654 articles were discarded because they did not meet our criteria for keyword combinations in the title or abstract. Of the 16 articles selected, 12 had research results. Of the total number of articles, there were 4 prospective articles and 8 retrospecitve articles, 4 were considered for conceptual theoretical aspects that are related to the objective of the study. Conclusion: an increase in the maternal mortality ratio was evident in the pre-pandemic period and during the pandemic compared to the figures from previous years, this was associated with the presence of comorbidities and maternal risk factors as well as the limited supply of health services, lack of intra-and extramural organization.

Factors associated with cost of adverse events in the intensive care unit: an economic evaluation performed in Bogotá, Colombia

BackgroundThe costs of adverse health events represent a significant burden of disease. Management of these adverse events also entails high costs to healthcare systems, reaching up to US$110 516.25 in...

Restructuring Non-teaching Hospitals into Teaching Hospitals in Iran: Component Change in General Hospitals

Background: The present study investigated how a general hospital is restructured in Iran when transforming from a non-teaching into a teaching hospital. Methods: This applied study was conducted based on a mixed-method design from 2020 to 2021 using a systematic search and review, document analysis, comparative and cross-sectional design, multiple voting technique, and qualitative phenomenological method. Results: The conceptual framework of the components of a hospital as a system includes inputs (governance and policy-making, goals and mission, clinical and support departments, physical space, clients, and human resources), processes (internal and external relations, key processes, type and level of services, and teaching mission systematization), and outputs (performance evaluation, internal and external customer satisfaction, human capital empowerment, organizational behavior, income-cost management, cost-effectiveness and efficiency, service quality, and legal and social responsibility). Conclusion: The findings from the present study depicted how the components of teaching and non-teaching hospitals are restructured when changing their functions. Restructuring an established organization, such as a hospital, is very challenging and requires multiple changes. This study had some implications including highlighting the need to formulate protocols for restructuring non-teaching hospitals into teaching hospitals or constructing new teaching hospitals, classifying teaching hospitals and clarifying their differences, focusing on the teaching mission in hospitals, and reviewing and updating the integration of medical education in providing health services.

Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited?

From the barber-surgeons of the Middle Ages to the digitally enabled clinical interventions of today, the role of nonspecialists in delivering accessible health care remains relevant and important. Their contribution in developing and supporting appropriate interventions and care pathways in the community can make a big difference for the overwhelming majority of children and young people with diagnosable mental health conditions who are not eligible for specialist treatment or do not seek help. Even if resources for specialist services were unlimited, there are independent benefits in involving nonspecialists in mental health care, albeit not without limitations and concerns. The natural shift over time in the boundaries of specialisms, the omnipresence and omnipotence of digital media in our lives and the vision of 'no wrong door' for service users, mean that it is not a question of whether, but of how, nonspecialists should be involved. We need to get past the point of considering them just as alternative providers of mental health interventions and services. Instead, they are best placed to protect children and young people's mental health through ubiquitous everyday actions, which counter the negative and maximise the positive elements in current practices, environments and interactions that influence families and communities.

Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol

BackgroundThis paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023.MethodsThis upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops.DiscussionThis protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other’s resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.

The effects of the SARS-CoV-2 pandemic on the delivery of maternal and child health services in South Africa

ObjectiveThe COVID-19 pandemic severely interrupted the functioning of healthcare systems, negatively affecting the global provision of maternal and child health (MCH) services. This study aims to specify the effects of COVID-19 on these services in the Gauteng province (South Africa) and to put forward context-specific recommendations aimed at augmenting them and ensuring ongoing uninterrupted coverage, even and especially during pandemics. MethodsIn this quantitative study, a retrospective review of District Health Information System data routinely collected between February 2019 and March 2021 was conducted, comparing performance of the relevant indicators across the two-year span. The data were analyzed using Stata 16 statistical software (StataCorp). The two sample t-test with equal variance and the Mann-Whitney test were applied to evaluate the equality of the indicators. ResultsRoutine MCH services were negatively impacted, with marked declines in all relevant indicators from the onset of the pandemic. There was a statistically significant decline in cervical cancer coverage and maternal postnatal visits within six days of delivery. While declines in the other critical indicators were likewise observed, they were not statistically significant. ConclusionThe South African response to the pandemic had negative repercussions on all MCH services in the Gauteng province. The lessons to be drawn from the pandemic experience should help to strengthen health system capacities, boost service provision, and mitigate future damage to the healthcare system.

Adolescent Perceptions of Teen Suicide: Implications from Focus Groups

Adolescent suicide is a growing public health concern. This research explores adolescent perceptions of suicide to identify potential focus areas for future prevention programming. This qualitative study utilized focus groups with 14 high school students. Thematic analysis was used to capture key concepts. Salient themes included: “Deciding whether suicide risk is real,” which spoke to the challenge in interpretating suicide-referencing language, and “Desire to engage in more conversations about mental health and suicide,” which suggested more potential benefit than detriment associated with explicit discussions with adolescents. Adolescents also identified the need for an alternative, “in between” adult contact who is not a school-affiliated counselor or a parent. These findings suggest adolescents may benefit from suicide prevention programming that emphasizes exchange and dialogue rather than just didactic instruction. Adolescent concerns about confidentiality may be addressed through use of K-12 partnerships with universities for mental health services provision.

Maternal Care of Preterm Infants after Discharge from the Neonatal Intensive Care Unit: A Rapid Review

Abstract The maternal care of infants poses a unique challenge for mothers, especially after discharge from the hospital. This review focused on the literature on maternal care of preterm infants at home after discharge from the hospital’s Neonatal Intensive Care Unit (NICU). A comprehensive literature search was conducted using keywords relevant to the topic. PubMed and EBSCO essential databases were searched for studies published between 2017 and 2023 (six years). Out of the 2903 retrieved studies, 7 were eligible and included in the review. The quality of available evidence was assessed using the Johns Hopkins Nursing Evidence Appraisal Tool (JHNEAT) and the Critical Appraisal Skills Programme (CASP) checklist. This review found that exclusive breastfeeding rates for preterm infants at home varied from 27% to 76% (Pooled prevalence of 48%) in data extracted from the studies conducted in Ethiopia (Africa), Brazil (South America), USA (North America), Denmark, and Italy (Europe). The practice of kangaroo mother care (KMC) for temperature regulation ranged from 41% to 83% (Pooled prevalence of 63%) in data extracted from studies conducted in Ethiopia (Africa) and Denmark (Europe). The review concluded that the care provided by mothers at home after discharge from the NICU was inadequate. Maternal and child health services providers should develop social media platforms to educate and encourage mothers to sustain exclusive breastfeeding and KMC practices after leaving the NICU.

Management of Muslim converts in Lebak Banten by YASMUI, Muhammadiyah, and Al Washliyah

The major challenges faced by Baduy converts in understanding and practicing Islam are due to limited access to formal Islamic education and the encroachment of Christian missionary activities. The purpose of this study is to explore and evaluate the effectiveness of Islamic philanthropy programs conducted by institutions such as YASMUI, Muhammadiyah, and Al-Washliyah in fostering the religious and social welfare of Baduy converts. This research uses a qualitative, descriptive-analytical research method, with a focus on the long-term sustainability of converts' development programs. Data collection was conducted through interviews, observation, and document analysis. The results show that Islamic education and social-humanitarian programs have had a positive impact on the religious understanding and social conditions of the Baduy converts. Collaboration between Islamic philanthropic organizations and the government is essential in providing free education facilities and social welfare services. The implication of the research shows that to optimize the sustainability and impact of these programs, continuous collaboration between the government and Islamic philanthropic institutions is essential. This includes the provision of formal education, health services and economic empowerment initiatives. In addition, this research highlights the need for improved infrastructure and support from the government to face the challenges posed by Christian missionary activities and to improve the overall welfare of the Baduy community.