Public Health Facilities Research Articles

Assessing the quality of data for selected reproductive health indicators in designated public health facilities in Bangladesh.

An effective health management information system plays a pivotal role in evidence-based decision-making and strengthening health service delivery in a country. The Directorate General of Health Services and the Directorate General of Family Planning of Bangladesh have adopted digital health management information system platforms named district health information system and management information system, respectively. Despite its significance, health management information system data has numerous issues, such as missing values, inaccuracies, lack of internal consistency, and the presence of outliers. This study aims to assess the data quality of reproductive health indicators in the health management information system of the Directorate General of Health Services and the Directorate General of Family Planning. The study examined two aspects of data quality: a) completeness of data, subdivided into completeness of facility reporting (report submission rate) and completeness of indicator data (presence of missing values); b) internal consistency of reported data, subdivided into presence of outliers, inter-indicator consistency, and consistency between reported data and original records (accuracy rate). The study utilised retrospective monthly data gathered from July 2021 to June 2022, covering 21 reproductive health indicators. Multi-stage cluster sampling was employed to select 112 health facilities for data collection, including 48 facilities from Directorate General of Health Services and 64 from Directorate General of Family Planning, representing various administrative levels across the country. The report submission rate for Directorate General of Health Services facilities was 98%, while for the Directorate General of Family Planning facilities, it was 86%. However, 35% of data points were missing in the district health information system server of Directorate General of Health Services, whereas no missing values were observed in the management information system server of Directorate General of Family Planning. Less than 3% of outliers were detected in the server data of both directorates. Inter-indicator consistency was maintained at a high rate of 98% in health facilities under both directorates. The accuracy of reported data varied across indicators and facility types: Directorate General of Health Services facilities showed accuracy rates ranging between 75 and 92%, with an aggregated rate of 86%. Different tiers of the Directorate General of Family Planning facilities had accuracy rates ranging from 92 to 96%. This research emphasises the significance of rectifying missing values, ensuring consistency, and improving reporting systems, with a particular focus on lower-tier health facilities, to enhance the validity and reliability of reproductive health data in Bangladesh.

An in-depth Analysis of the Degree of Implementation of Integrated Care for Diabetes in Primary Health Care in Cambodia.

With the rising prevalence of type 2 diabetes (T2D), three care initiatives for T2D are being scaled-up in Cambodia to improve availability and accessibility of integrated care for T2D: (1) hospital-based care, (2) health centre-based care, and (3) community-based care. This case study aims to share learnings from an in-depth analysis of the level of integrated care implementation in these care initiatives for T2D in Cambodia. Twenty public health facilities in five operational districts were assessed on six integrated care components: (1) early detection and diagnosis, (2) treatment in primary care services, (3) health education, (4) self-management support, (5) structured collaboration, and (6) organisation of care. Two raters independently scored each facility on a 0-5 scale based on multiple sources of data and reached a consensus. The in-depth analysis showed that the three care initiatives were not implemented in an integrated manner, with low implementation scores (1 or 2 out of 5) in all selected settings. The presence of health centre-based care was associated with higher scores for early detection and diagnosis and treatment in primary care services, while the presence of community-based care was related to structured collaboration and organisation of care. The evidence suggests that while each care initiative has its potential contributions towards integrated care for T2D, the three care initiatives should be effectively implemented in an integrated manner in order to potentially produce the desired outcomes.

Prevalence of postpartum depression and its association with diabetes mellitus among mothers in public health facilities in Mbarara, Southwestern Uganda

ABSTRACT Postpartum Depression (PPD) is a major health challenge with potentially devastating maternal and physical health outcomes. Development of diabetes mellitus has been hypothesized as one of the potential adverse effects of PPD among mothers in the postpartum period, but this association has not been adequately studied especially in low resource settings. This study aimed at determining prevalence of postpartum depression and its association with diabetes mellitus among mothers in Mbarara District, southwestern Uganda. We conducted a facility based cross-sectional study of 309 mothers between 6th week to 6th month after childbirth. Using proportionate stratified consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health center IV. PPD was diagnosed using the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Diabetes mellitus was diagnosed by measuring Hemoglobin A1c (HbA1c). Logistic regression was used to determine the association of PPD and diabetes mellitus among mothers. The study established that PPD prevalence of PPD among mothers of 6th weeks to 6th months postpartum period in Mbarara was 40.5% (95% CI: 35.1–45.1%) and it was statistically significantly associated with diabetes mellitus in mothers between 6 weeks and 6 months postpartum. The prevalence of diabetes mellitus among mothers with PPD was 28% compared to 13.6% among mothers without PPD. Mothers with PPD had 3 times higher odds of being newly diagnosed with diabetes as compared to those without PPD (aOR = 3.0, 95% CI: 1.62–5.74, p = 0.001). Mothers with PPD between 6 weeks and 6 months postpartum are more likely to have diabetes mellitus as compared to those without PPD. Well-designed prospective analytical studies are needed to conclude on the risk of diabetes mellitus in relation to PPD. Early screening of PPD may be considered in postpartum mothers.

Retrospective Investigation of Prevalence and Trends of STDs in Public Health Facilities in the Tigray Regional State, Ethiopia from July 2019-June 2020

There is a significant and rising occurrence of major treatable sexually transmitted infections (STIs) in sub Saharan Africa, particularly in Ethiopia. The engagement of teenagers in sexual activities without parental oversight continues to pose a public health threat. This study seeks to evaluate the prevalence and trends of significant treatable STIs within our region. <i>Methods: </i>3,500 patients with STI symptoms who were seen in all medical facilities between July 2019 and June 2020 were included in a retrospective cross-sectional study with descriptive statistics analysis to compare prevalence and trend measures by age group, sex, and month. Tables and bar graphs were used to present the results. <i>Result: </i>The data indicated a higher prevalence of STIs among males compared to females. The sexually active adult population exhibited a notable incidence of sexually transmitted diseases, with 52.7% of cases being male and 47.3% female. The specific STIs identified included genital candidiasis at 18.3%, hepatitis B at 16.9%, gonorrhea at 16.3%, hepatitis C at 13.6%, syphilis at 11.8%, genital herpes at 8.8%, genital warts at 7.5%, and Chlamydia at 6.8%. The incidence of syphilis showed an increase from 2.2% to 4.2% in 2020, while the trends for other STIs were more variable. <i>Conclusion: </i>Sexually transmitted diseases predominantly impact adults, with prevalence rates differing by gender and age group, and exhibiting a non-linear trend across most age categories. These findings offer essential insights into the epidemiological landscape of the country, suggesting the need for future prevention strategies that target adults at the highest risk for sexually transmitted infections.

Determinants of treatment-seeking behaviour and healthcare provider choice in Afghanistan in 2018: a cross-sectional study

IntroductionIn Afghanistan, remarkable achievements have been made in improving access to healthcare and health outcomes since the introduction of essential healthcare packages. Nonetheless, sociodemographic and geographical inequities persist, and out-of-pocket...

Schistosoma mansoni and soil-transmitted helminthic infections and associated factors among pregnant women in Jimma Town, Southwest Ethiopia

BackgroundSchistosomiasis and soil-transmitted helminth (STH) infections occurring during pregnancy may pose adverse health consequences to the mother and the developing baby. This study aims to determine the prevalence of Schistosoma mansoni and STHs, and their association with adverse birth outcomes among pregnant women in Jimma Town.MethodsA cross-sectional study involving 314 pregnant women was conducted in Jimma Town, Southwest Ethiopia. The pregnant women were recruited from selected public health facilities during their antenatal care (ANC) visits from August to December 2021. Data on demographic characteristics and factors associated with S. mansoni and STH infections were collected using a pretested questionnaire. Moreover, during the third trimester, stool specimen of each pregnant woman was examined using Kato-Katz technique, and hemoglobin was measured using a HemoCue analyzer. Data on adverse birth outcomes were collected during delivery. Data were analyzed using STATA-MP_12 (StataCorp., TX, USA).ResultsThe overall prevalence of intestinal helminthic infections was 26.1%. Soil-transmitted helminths and S. mansoni were detected in 20.4% (95%CI: 15.9–24.8) and 5.7% (95%CI: 3.2–8.3) of the pregnant women, respectively. The magnitude of low birth weight was 6.4%, higher in those with late-term delivery and maternal anemia (p < 0.05). Maternal anemia was also associated with post-partum bleeding (p < 0.05). Pregnant women who carry out laundry activities in the river were significantly more infected by S. mansoni (AOR 10.7, 95% CI: 2.2–51.9).ConclusionsThis study sheds light on the burden of maternal STH and S. mansoni infections in Jimma Town. A quarter of the pregnant women were infected with STHs and S. mansoni. It is recommended that pregnant women in the area avoid washing clothes in the river to reduce the risk of S. mansoni infection. Screening for intestinal parasitic infections should be conducted for pregnant women living in endemic areas during their ANC follow-up.

Perception, practice and associated factors of labour pain management among obstetric care providers in public health facilities in Harari Region, Ethiopia: a multicentre cross-sectional study.

Although providing relief from labour pain can improve the mother's satisfaction with the birthing process and lead to better reproductive outcomes. This study aims to evaluate the perceptions, practices and related aspects of labour pain management among obstetric care providers in public health institutions in the Harari Region of Ethiopia. A cross-sectional study was conducted in the labour and delivery wards of public health facilities in the Harari Region. Data were collected using a semi-structured and pretested self-administered questionnaire among systematically selected obstetrics care providers (OCPs). A multivariate logistic regression model was used to identify factors associated with the practice of labour pain management. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine the strength of associations and a p-value <0.05 was considered significantly associated. Data from 234 OCPs were employed for analysis. A total of 70.9% of OCPs have positive perceptions and 69.7% practiced labour pain management in the past 4weeks. Being a female (adjusted OR [aOR] 2.33 [95% CI 1.06 to 5.15]), having a positive perception (aOR 7.76 [95% CI 3.21 to 18.72]), being a physician (aOR 6.35 [95% CI 1.94 to 20.82]), being a midwife (aOR 5.28 [95% CI 1.78 to 15.63]) and being a highly qualified OCP (aOR 17.89 [95% CI 5.22 to 61.30]) were associated with being more likely to practice labour pain management. Positive attitude (aOR 2.77 [95% CI 1.51 to 8.72]), being a physician (aOR 6.01 [95% CI 1.23 to 29.35]) and practicing labour pain management (aOR 12.89 [95% CI 4.57 to 36.38]) were associated with labour pain management perceptions. Seven of ten OCPs practiced labour pain relief methods and had a positive perception of managing labour pain. Therefore, facilitating training and improving the perceptions and attitudes of OCPs towards labour pain management should be encouraged.

Layers of inequality: gender, medicalisation and obstetric violence in Ghana

BackgroundThis study explored how gender inequalities in health systems influence women’s experiences of obstetric violence in Ghana. Obstetric violence is recognised as a major public health concern and human rights violation. In particular, it reduces women’s trust and use of health facilities for childbirth, thereby increasing the risks of maternal and neonatal mortality. In Ghana, obstetric violence is pervasive and normalised; yet, little is known about the gendered dynamics of this phenomenon.MethodologyA qualitative study was conducted in eight public health facilities in Ghana. Specifically, semi-structured interviews were conducted with 30 midwives who work in the maternity units and 35 women who have utilised the obstetric services of the hospitals for childbirth. The midwives and women were selected using the purposive sampling technique. The transcripts of the interviews were coded using NVivo qualitative data analysis software and were thematically analysed. Secondary materials such as existing data on the medical profession in Ghana were utilised to complement the primary data.ResultsThe study revealed that there are huge structural inequalities that keep women at the lower cadres of the health system. Five major themes depicting how gender inequalities contribute to women’s experiences of obstetric violence emerged: gender inequality in the medical profession, unequally and heavily tasked, feminisation of midwifery, patriarchal pressures and ideologies, and gender insensitivity in resource provision. These inequalities impact the kind of care midwives provide, which is often characterised by mistreatment and abuse of women during childbirth. The study also discovered that patriarchal ideologies about women and their bodies lead to power and control in the delivery room and violence has become a major instrument of domination and control.ConclusionThe hierarchical structure of the healthcare profession puts the midwifery profession in a vulnerable position, with negative consequences for maternity care (obstetric violence). The study recommends that gender-responsive approaches that address structural inequalities in health systems, women’s empowerment over their bodies and male involvement in women’s reproductive care are crucial in dealing with obstetric violence in Ghana.

Associating socioeconomic factors with access to public healthcare facilities using geographically weighted regression in the city of Tshwane, South Africa.

Access to healthcare is influenced by various socioeconomic factors such as income, population group, educational attainment and health insurance. This study used Geographically Weighted Regression (GWR) to investigate spatial variations in the association between socioeconomic factors and access to public healthcare facilities in the City of Tshwane, South Africa based on data from the Gauteng City-Region Observatory Quality of Life Survey (2020/2021). Socioeconomic predictors included population group, income, health insurance status and health satisfaction. The GWR model revealed that all socioeconomic factors combined explained the variation in access to healthcare facilities (R²=0.77). Deviance residuals, ranging from -2.67 to 1.83, demonstrated a good model fit, indicating the robustness of the GWR model in predicting access to healthcare facilities. Black African, low-income and uninsured populations had each a relatively strong association with access to healthcare facilities (R²=0.65). Additionally, spatial patterns revealed that socioeconomic relationships with access to health care facilities are not homogeneous, with significance of the relationships varying with space. This study highlights the need for a spatially nuanced approach to improving healthcare facilities access and emphasizes the need for targeted policy interventions that address local socio-environmental conditions.

Availability, price, and affordability of diabetes mellitus and thyroid dysfunction medicines in South Wollo zone, Northeast Ethiopia

BackgroundDiabetes mellitus and thyroid dysfunction are prevalent endocrine disorders that impose enormous burdens on patients and countries. However, access to essential medicines remains inadequate in many low-income countries. This study evaluated medications’ availability, price, and affordability for these conditions.MethodsA cross-sectional study was conducted at health facilities in the South Wollo zone in 2022. Following World Health Organization (WHO)/Health Action International (HAI) guidelines, 34 medicines were evaluated across 60 medicine outlets. Data were collected using a standardized tool adapted from WHO/HAI. Availability was measured by the percentage of facilities where the medicines were in stock. Prices were reported as median prices and median price ratios (MPR). Affordability was assessed based on the number of days’ wages required for the lowest-paid government workers to cover the full course of therapy.ResultsThe availability of lowest-priced generic (LPG) diabetes and thyroid dysfunction medicines in the public sector was 24.4% and 28.7%, respectively. In private pharmacies, availability was 26.3% for diabetes and 21% for thyroid dysfunction medicines. Median prices for LPG medicines were higher in private pharmacies than in public health facilities, with 81.81% showing a statistically significant difference (p < 0.05). In private pharmacies, the prices of LPG diabetes (5, 71.43%) and thyroid dysfunction medicines (5, 83.33%) exceeded the reference price. None of the LPG diabetes and thyroid dysfunction medicines were affordable in either setting.ConclusionsThe study revealed a very low availability of medicines and a financial burden on patients. Therefore, the government should improve the availability of these essential medicines and regulate their prices.

Good practices to optimise the performance of maternal and neonatal quality improvement teams: Results from a longitudinal qualitative evaluation in South Africa, before, and during COVID-19.

Many maternal and neonatal deaths can be avoided if quality healthcare is provided. To this end, the South African National Department of Health implemented a quality improvement (QI) programme (2018-2022) to improve maternal and neonatal health services in 21 public health facilities. This study sought to identify good practices aimed at improving QI teams' performance by identifying optimal facility-level contextual factors and implementation processes. We purposively selected 14 facilities of the 21 facilities for a longitudinal qualitative process evaluation. We interviewed 17 team leaders, 47 members, and five QI advisors who provided technical support to the teams. The data were analysed using framework analysis. We choose the Consolidated Framework for Implementation Research as framework given that it explicates contexts and processes that shape programme implementation. Six quality improvement teams were assessed as well-performing, and eight as less well-performing. This research conceptualises a 'life course lens' for setting up and managing a QI team. We identified eight good practices, six related to implementation processes, and two contextual variables that will optimise team performance. The two most impactful practices to improve the performance of a QI team were (i) selecting healthcare workers with quality improvement-specific characteristics, and (ii) appointing advisors whose interpersonal skills match their technical quality improvement competencies.

Costs of the Supervision, Performance Assessment and Recognition Strategy (SPARS) for improving medicines management in Nepal.

Nepal implemented a pilot of the Supervision, Performance Assessment, and Recognition Strategy (SPARS) program aimed to increase health workers' ability to manage medicines through on- the-job training and support from a new cadre of Medicines Management Supervisors (MMS). This study aims to assess the implementation costs. Data from the SPARS central database and facilities was analysed to assess the total cost of the SPARS pilot including 293 public health facilities from 12 districts of 3 provinces, from May 2022 until July 2023. We estimated the number of health facilities to achieve a successful performance status, defined as a SPARS score ≥ 18.75 out of 25 (75%) and estimated the cost per facility to reach a successful score. In total, 293 facilities received 838 visits, performed by 48 MMS for an estimated total cost of $226,531. 124 facilities (44.3%) reached a score of 18.75 points after two or more visits. On average, it costs $1827 USD per facility to reach a successful SPARS score. This study assesses the costs of implementing SPARS in 12 districts in Nepal. These findings can provide insights into further scaling up SPARS in Nepal or in other countries.

Considering patient-centred care and patient empowerment as essential to quality health care delivery in Ghana.

Rising cases of non-communicable diseases (NCDs), poor health choices, mistrust of the health system, self-medication, resistance of diseases to medication and dissatisfaction with the service experience serve as red flags on the path to Universal Health Coverage (UHC). This study explored the importance of patient-centred care (PCC) and patient empowerment (PE) within the context of healthcare service delivery in Ghana. The study considered PCC and PE from the perspective of three public healthcare facilities within the Greater Accra region. The researcher adopted a qualitative exploratory research approach. The study employed purposive sampling for the selection of healthcare facilities and healthcare providers. Convenience sampling was applied to select patient participants. A total of 33 in-depth interviews and 4 focus group discussions (FGDs) were conducted across the three sampled facilities as part of the data collection process. Healthcare providers and patients unanimously view quality as essential for effective healthcare delivery. The application of the capacitating role of PE and PCC is inexact and largely left to subjective interpretation. The Ministry of Health (MOH) has recognised that patient experiences, a key indicator of care quality, have often been suboptimal and is actively working to address these weaknesses. This study supports the call for health systems to remain committed to efforts to achieve UHC, with a focus on PCC and PE.

Knowledge and attitudes of health care professionals regarding birth preparedness of women in labour at selected Hospitals in KwaZulu-Natal, South Africa: A qualitative study

Introduction Low and middle-income countries account for the largest proportion of women’s deaths as a result of pregnancy or childbirth-related complications. The sub-Saharan region is the most affected with approximately 70% (202 000) of maternal deaths between 2000 and 2020. These deaths could have been prevented if expectant mothers were prepared for childbirth. Birth preparedness is perceived as a better strategy that helps attain a substantial reduction in maternal mortality. This is achieved by attending early antenatal classes, receiving skilled care during childbirth, and care and support right after birth. The latest survey on antenatal class attendance conducted in South Africa provides an estimated 30.8% of expectant mothers in public healthcare facilities. Methods This study employed a qualitative approach to collect data, as a result, one focus group discussion with five (N=5) participants and two others with six (N=6) participants each (n=6X2=12) and twenty individual interviews were conducted. The study sought to explore and describe the knowledge and attitudes of healthcare professionals regarding the birth preparedness of women in labour at selected hospitals in Durban KwaZulu-Natal. Results Expectant mothers were unprepared for both labour and postnatal care. The unprepared expectant mothers were uncooperative and made the task of midwives difficult to the extent of endangering the life of their expected newborn babies and their own. Factors such as finance, heterogeneity, staff shortage, language barrier, lack of family support, lack of interest, cultural beliefs, and confusion caused by various sources of information were responsible for birth unpreparedness. Conclusion The synergy between expectant mothers and midwives appears to be an important factor in achieving better birth preparedness.

Illustrations of Coping and Mental Well-Being of Adolescents Living with HIV in Cape Town, South Africa During COVID: A Photovoice Study.

Adolescents living with HIV (ALHIV) are the fastest-growing population living with HIV globally. The COVID-19 pandemic disrupted health systems, thereby negatively affecting the quality and availability of HIV care and support services. This study describes the challenges and treatment experiences of ALHIV on ART at a public primary healthcare facility in a low-socioeconomic community in Cape Town, South Africa during the COVID-19 pandemic. A qualitative photovoice study was conducted with 21 adolescents (aged 14-19 years; 13 females and 8 males). Participants shared pictures illustrating their experiences during the COVID-19 pandemic in groups. Group discussions were audio-recorded and transcribed in full and subjected to content analysis. Seven themes emerged describing ALHIV's personal, social, and economic challenges, their means of coping, and feelings of vulnerability. Challenges included the loss of significant others, lack of social support and opportunities, experiences of HIV-related stigma and discrimination in the household, loneliness, and isolation. In spite of difficulties, some ALHIV displayed resilience by continuing their medication routines during lockdown periods. After the COVID-19 pandemic, there is a need for the restoration of the health system and services, including psychosocial support to re-engage ALHIV in care and treatment.

Cross sectional survey of maternal and newborn quality of care in Niger: Selected findings, lessons learned and recommendations.

Comprehensive assessments of quality of care (QoC) are essential for monitoring progress towards meeting global and national maternal and newborn health (MNH) targets. Liverpool School of Tropical Medicine (LSTM) and the Niger Ministry of Public Health adapted a 2014 WHO QoC tool to cover antenatal care (ANC) and postnatal care (PNC) and include client voices through exit interviews. The objectives of the study were to assess quality of MNH care in Niger and to document lessons learnt from implementing the LSTM QoC tool. Quality of Care (QoC) was assessed using five tools: health facility survey (using register and official record data), partograph reviews, healthcare provider knowledge assessment, exit interviews with clients, and observation of antenatal and postnatal care. A nationally representative sample of 110 public healthcare facilities at three levels (integrated health centres, district hospitals and mother-child hospitals) and 2153 women were included. Descriptive analysis with 95% confidence intervals was presented. The health facility survey showed variable access to electricity (63% [53-72]), water (72% [62-81]), and transportation (40% [31-50]). Tests and treatment for HIV, TB, and malaria were found in more than 90% of relevant facilities. During observation of first ANC visit, 62% [48-74] women were tested for HIV; 13% [5-30] for pre-eclampsia and 22% [12-36] for anaemia. Observation of PNC showed much lower rates of screening (15% [7-27] tested for HIV and 4% [0;11] for malaria). Partographs were used in 86% of deliveries with inconsistent completion. At client interviews, respectful care indicators were variable, with providers not always explaining results to clients (59% [50-67]). Targeted allocation of resources and training could impact on QoC and reduce missed opportunities for prevention, screening and management of diseases among pregnant women and babies. The QoC assessment tool proved capable of offering a comprehensive overview of priorities in MNH, while maintaining feasibility in the Nigerien context.

Perception of health workers and assessment of tree spp. Composition in adeoyo general hospital, ibadan, oyo state

Trees as a crucial component of forest play a vital role in providing a wide range of products and services including health benefits. The lack of information on tree species composition and diversity around public health care facilities in Ibadan may hinder comprehensive understanding of the ecological value and potential benefits that trees provide to the surrounding environment and public health care facilities. This study assessed the perceptions of health workers and evaluation of trees within the premises of Adeoyo General Hospital, Ibadan. Forty-nine (49) Structured questionnaire was used to derive the perceptions, while total enumeration of all the trees with diameter at breast height (DBH) greater than or equal to 10 cm were identified and enumerated in the study area. Tables and percentages were used to analyze the perception of the health workers while data collected on dbh (cm) and total height (m) were used to compute basal area (m2) and volume (m3). The analysis of socio-demographic data revealed a higher representation of female health workers (61.2%), a concentration of professionals in the 30 to 39 age group (46.9%), and a predominant presence of married individuals with tertiary education. Examining health workers' perceptions, a significant consensus emerges on the positive effects of tree exposure. Workers believed that exposure to trees improve patient clinical outcomes, speeds up recovery, and boosts the immune system (42.9%). There is also recognition of the role of trees in reducing stress levels and enhancing focus for both patients and healthcare workers. The positive correlation between trees around healthcare facilities and increased staff satisfaction is noteworthy. In the study area, Azadirachta indica was the dominant tree species constituting 42.2% of the total population. Terminalia catappa and Gliricidia sepium are also of great significance. Mean diameter, height, basal area, and volume suggest a diverse forest with a wide range of tree sizes. Meliaceae dominated the families with 42.2% while other families like Fabaceae and Combretaceae also contributed to biodiversity and ecological significance. In DBH, Delonix regia had the highest value of 198.3cm while Newbouldia laevis had 15.1 cm as the lowest value. Antiaris africana and Azadirachta indica both had the maximum values of 19.8 m and 51.8 m3 in height and basal area respectively. Species diversity indices indicated a diverse forest ecosystem with 13 identified taxa and 64 individuals. The diversity index (Shannon-Wienner) of 1.89 - though it is low- is within the general limit for tropical forests. It is therefore recommended that integration and management of green spaces in healthcare facility design, development of employee wellness programs, promoting nature exposure, educational initiatives on the benefits of nature and economic valuation studies should be greatly considered.

Shaping Patient Loyalty through Quality Care: Analyzing Patient Satisfaction in Public Hospitals in Ghana

Public hospitals in Ghana face challenges such as limited resources and inconsistent care delivery, which impact patient satisfaction and loyalty. In this context, enhancing service quality is crucial for retaining patients and improving healthcare outcomes. This study investigates the role of service quality in shaping patient loyalty and explores patient satisfaction as a mediator in selected public hospitals in Ghana using the SERVQUAL model. A survey was conducted among 200 outpatients from five public health facilities in Kumasi, Ghana, between January and February 25, 2024. A quantitative methodology was applied to evaluate how patients' perceptions of service quality influence their loyalty toward public healthcare providers. In order to analyze the data, SPSS and the smart partial least square (PLS) software version 3.0 were used for structural equation modeling (SEM). The findings revealed that communication, the physical environment, and responsiveness significantly affect patient loyalty, whereas factors such as privacy, safety, and a customer-friendly atmosphere do not. Additionally, this study confirmed that patient satisfaction mediates the relationship between service quality and patient loyalty, underscoring the importance of service quality in enhancing both satisfaction and loyalty in health care. Based on these insights, this study recommends that health care institutions improve their service quality to strengthen public healthcare systems. The significance of this paper extends beyond regression analysis, as it also addresses the delayed effects of service quality on patient loyalty, considering both direct and indirect influences in the regression models.

Assessment of Midwives’ Knowledge and Application of the Modified WHO Partograph at Ga South Public Health Facilities, Greater Accra, Ghana

Background The partograph, one of the vital tools available for the midwife, was originally developed from Friedman’s 1954 Cervicograph by Philpott and Castle in 1972. It was later modified and adopted by the WHO as a universal ‘gold standard’ tool for recording and monitoring progress in labour and providing interventions in cases of abnormal labour. The goal of this study was to assess the level of knowledge of midwives and their utilisation of the modified WHO partograph at the Ga South Municipality in the Greater Accra Region of Ghana. Methodology An institution-based quantitative cross-sectional study was conducted within the municipality from February to March 2019. One hundred and ten (110) midwives were recruited using the census approach. Data were collected using a structured self-administered questionnaire. STATA statistical software version 14 was used for descriptive analysis and results were reported in the form of percentages and frequencies using charts and tables. Pearson’s Chi-Square estimation was also performed to test the association between selected variables with a p value &lt;.05 as the threshold for statistical significance. Results Of the 110 participants, 105 (95.5%) of the midwives could properly describe the partograph and 104 (94.5%) understood that it was used as a tool for vital decision-making, while 92 (83.6%) indicated that partograph contributes in reducing maternal and new-born deaths. Almost all participants, 109 (99.09%) knew all the parameters of the partograph and were also aware that plotting the partograph begins at a cervical dilation of 4 cm. Also, while a good number of participants 103 (93.64%) knew that cervical dilation on the partograph is carried out every four hours during the active phase of labour, 110 (100%) indicated that progress of labour is assessed by the degree of cervical dilation and descent of the presenting part. Routine usage of the partograph was recorded among the majority of midwives, 102 (92.7%), to record and monitor the progress of labour in expectant women. Bivariate analysis showed a significant association between the use of the modified WHO partograph and the knowledge of midwives on Ghana Health Service (GHS) policies ( p = .045). There was, however, no positive association determined among age ( p = .66), rank ( p = .77), years of professional experience ( p = 1.00), place of work ( p = .51), work shift and highest qualification ( p = 1.00) as far as knowledge and use of the WHO modified partograph are concerned. Conclusion The findings of the study underscore the desirable level of knowledge and usage of the partograph among study participants. This affirms that the knowledge and usage of the partograph within the facilities in Ga South health facilities hold the prospect of enhancing the safety of expectant mothers.

Maternal mortality in Panama from 1998 to 2022.

To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R 2 was performed to analyze the data. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R 2 = 0.1 (y = -0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R 2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.