Public Health Hospital Research Articles

Trends in Clostridioides difficile infection across a public health hospital system in New York City 2019-2021: A cautionary note

Contrary to national reports, rates of healthcare facility-onset Clostridioides difficile infection across an 11-hospital system rose after the spring of 2020, when New York City was the epicenter for the COVID-19 pandemic. Antibiotic pressure from an escalation in cephalosporin usage correlated with this increase. The majority of cases of Clostridioides difficile were in patients without COVID-19, suggesting the pandemic has adversely impacted the healthcare of other inpatients.

Assessment of medication discrepancies with point prevalence measurement: how accurate are the medication lists for Swedish patients?

BackgroundMedication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements.MethodsParticipants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used.ResultsIn total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029).ConclusionMedication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.

Views and practices on medical cannabis of unlicensed providers in Thailand: a qualitative study

Background: Despite the legalization of cannabis use for medical purposes in Thailand in February 2019, illicit providers are still widespread and accessible. This study aimed to understand why people still chose to receive medical cannabis treatment or products from unlicensed or illegal providers. The practices of unlicensed or illegal providers in provision of medical cannabis products or treatment services were also examined. Methods: Qualitative in-depth interviews were conducted among medical cannabis providers and users, including 36 unlicensed and 7 licensed providers and 25 users in 2019-2021. Snowball sampling was used to recruit participants until saturation of data was achieved. Interviews included open-ended questions about the providers’ practices and attitudes towards medical cannabis. Interviews were recorded and transcribed, and thematic analysis was performed. Results: Overall, six reasons were identified to answer why unlicensed/illicit providers were still popular, including: 1) easy accessibility; 2) familiarity with the unlicensed providers before the legal scheme became available; 3) favorable characters (kind, supportive, non-judgmental) of unlicensed providers; 4) affordable treatment fees; 5) trust in the quality of the medicines; and 6) lack of knowledge and negative attitudes towards cannabis from healthcare professionals. Most providers started their career as medical cannabis providers by using it themselves or with their relatives and being satisfied with the results. They used cannabis products to treat all diseases, including skin, eyes, HIV/AIDS, non-communicable diseases and all kinds of cancers. Additionally, they believed that it was effective, with no or minimal adverse effects. Conclusions: This study suggests that some patients will continue receiving medical cannabis treatment and products from unlicensed or illegal providers. More attention should be paid on increasing the capacity of medical cannabis service systems within public health hospitals, and the certification of unlicensed providers, so as to integrate them into a regulated system.

How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals.

Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.

Analysis of Self-Medication Patterns in South Surabaya Community in the Era of the COVID-19 Pandemic

Background: Indonesia implemented a large-scale social restriction policy throughout the COVID-19 pandemic. Hospitals and alternative health care facilities are places with a high risk of COVID-19 transmission. The general public is suggested to limit visits to health facilities unless it is an emergency. Supported this, we hypothesize that people prefer to self-medicate to take care of relatively mild health complaints at home. This study aims to analyze the pattern of self-medication within the community in the era of the COVID-19 pandemic. Methods: A cross-sectional survey was conducted on 110 residents of South Surabaya with a structured questionnaire during the COVID-19 outbreak in December 2021, to observe patterns and factors that influence people's decisions to take self-medication before and during the COVID-19 pandemic era. Results: As several as 40% of respondents had self-medication before the COVID-19 pandemic, while the prevalence of self-medication within the thick of the COVID-19 outbreak was 57.3%. The most reasons for self-medication are the concern of reaching the hospital will be being exposed to COVID-19 (67.3%), the sickness is not severe enough, compatible with the previous medication, and more efficient. The community's advantages of self-medication are that it is faster to treat (41%) and cheaper (21.8%). Conclusions: The study revealed that there was an increase in the number of respondents who did self-medication during the COVID-19 pandemic with the main reason being fear of going to the public health center or hospital.

Analysis of Disaster Medical Response: The Sejong Hospital Fire.

This paper provides a field report on a fire that broke out on January 26, 2018 at Sejong Hospital in Miryang, South Korea, engendering the establishment of a committee to investigate the hospital fire response. This field report analyzes the disaster medical response. The official records of the disaster response from each institution were examined. On-site surveys were conducted through interviews with government officials and other health care workers regarding communication during the disaster response without using a separate questionnaire. All medical records were abstracted from hospital charts. There were 192 casualties: 47 victims died, seven were seriously injured, and 121 suffered minor injuries. Emergency Medical Services (EMS) arrived three minutes after the fire started, while news of the fire reached the National Emergency Medicine Operation Center based in Seoul in 12 minutes. The first disaster medical assistance team (DMAT) was dispatched 63 minutes after the National Emergency Medicine Operation Center was notified. The disaster response was generally conducted in accordance with disaster medical support manuals; however, these response manuals need to be improved. Close cooperation among various institutions, including nearby community public health centers, hospitals, fire departments, and DMATs, is necessary. The response manuals should be revised for back-up institutions, as the relevant information is currently incomplete.

Maternal dietary diversity and nutritional adequacy in relation with anthropometric measurements of newborns at birth: a cohort study in Tehran city

BackgroundMaternal dietary intake during pregnancy plays an important role in fetal development and birth outcomes. The aim of the present study was to determine maternal dietary diversity and Nutritional adequacy in relation with anthropometric measurements of newborn at birth as a cohort study in Tehran city.MethodsThis prospective cohort study, was conducted by participation of 585 pregnant women referred to public health centers and hospitals covered by Shahid Beheshti, Tehran and Iran Universities in Tehran City. Using face-to-face interviews, general characteristics were obtained by questionnaire. Pre-pregnancy dietary intake was measured by a 168-item semi-quantitative food frequency questionnaire at the first visit, and dietary intake during pregnancy was measured by 2 non-consecutive 24-h food recall (one holiday and one regular day) at 31–34 weeks. Maternal height and weight were measured using standard tools and protocol at the first visit, and maternal weight at the end of pregnancy and data related to neonatal anthropometric indices were collected from mothers and neonates health records in the Sib electrical system. By applying SPSS software (version 23) the association was analyzed by linear regression with adjusting for confounding factors. P-value< 0.05 was considered as significant.ResultsMean ± standard deviation of body mass index (BMI) of pre-pregnancy, pregnancy weight gain, BMI for age z-score (BAZ) at birth of infants were 24.52 ± 4.12, 12.16 ± 6.85 kg and − 0.61 ± 1.48, respectively. Mean ± SD of the Dietary Diversity Score (DDS) and Mean Adequacy Ratio (MAR) before and during pregnancy were 5.31 ± 1.11, vs.5.23 ± 1.42 and 289.85 ± 113.12 vs. 371.07 ± 197.28, respectively. After adjusting for confounding factors DDS in the third trimester of pregnancy was inversely correlated with WAZ (B = -0.16, 95% CI = - 0.23_0.30) and BAZ (B = − 0.24, 95% CI = - 0.06_0. 42) at birth, MAR of pre-pregnancy (B = − 0.001, 95% CI = - 0.002_0.00) and in the third trimester of pregnancy (B = − 0.18, 95% CI = - 0.35_0.004) were negatively associated with WAZ at birth.ConclusionThe findings showed that maternal nutritional status (dietary diversity and nutritional adequacy) before and during pregnancy were correlated with neonatal anthropometric indices at birth.

A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital

Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage. We compared the VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with the Roche Elecsys Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) to recognize past infections and to compare VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with Abbott Real Time PCR SARS-CoV-2 assay to recognize infection during its acute phase so that it's possible to evaluate the use of commercially available assays in clinical practice. Of the 1,100 patients tested with serological and rapid test, 1,085 were negative both to serological and rapid test, 4 patients were positive at rapid (2 for IgM and 2 for IgG) but negative serological test, 11 patients were positive at serological test but negative to rapid. Of the 300 tested with oropharyngeal swab and rapid test, 294 were negative both to swab and rapid test, 2 positives both to swab and rapid test, 3 positives at swab but negative at rapid test, 1 negative at swab but positive at rapid test. the combined use of these tests according to the specific needs of users, allows a reliable identification of infected patients in the acute phase, distinguishing them from subjects with an antibody response from a previous infection.

P42 Pattern of antibiotics resistance and phenotypic characterization of MDR bacteria isolates in four hospitals of Littoral Region, Cameroon

BackgroundContaminated hospital surface have been recognized to be the most significant reservoir of MDR bacteria (MDRB). The aim of this study was to describe phenotypical characteristics of MDRB species surface contaminants in four hospitals of Littoral region, Cameroon.MethodsWe conducted a descriptive hospital-based cross-sectional study from December 2018 to May 2019. A simple random sampling was used to swab 10 selected equipment items and 10 materials in the mornings after disinfection but before the start of work in seven units (Medical, Paediatric, Operating Theatre, Laboratory, Surgical, Emergency and Maternity). After inoculation in four agar media consecutively (eosin methylene blue, CLED, mannitol salt agar and blood agar) and incubation in appropriate conditions, the Kirby–Bauer disc-diffusion method was used for antimicrobial susceptibility testing. Phenotypic methods using specific indicator discs were used for screening and confirmation of MDRB, of which: ESBL-producing, MRSA, vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant Enterococcus faecalis (VRE),vancomycin-resistant CoNS (VRCoNS), MDR and XDR. Control strains, Escherichia coli ATCC 25922 (non ESBL-producer) and Klebsiella pneumoniae 700603 (ESBL-producer) and S. aureus ATCC 25923 (MSSA) were used to ensure ability to support growth of the target organism(s), ability to produce appropriate biochemical reactions and adequate inhibition zone diameters.ResultsAmong 50.4% (119/236) showed positive bacteria growth, a total of 89 (13 species), predominant bacteria and those more likely to cause nosocomial infections were selected and tested each one with 18 antibiotics. There was high level of resistance to penicillin [amoxicillin (77.5%) and oxacillin (76.4%)], followed by 3G cephalosporin [ceftazidime (74.2%)] and monobactam [aztreonam (70.8%)]. Although the least level of resistance was observed in carbapenem [imipenem (5.6%)]. The overall prevalence of MDRB was 62.9% (56/89). MRSA were the most detected 57.5% (30/89), followed by ESBL 10.1% (9/89). The lowest percentage was recorded by VRE and XDR both with 1.1% (1/89). According to the type of MDRB in selected isolated bacteria, all the strains (100%) of two species, Aeromonas hydrophila and Enterococcus faecalis, were characterized MDRB. However, S. aureus strains reported significant rate of MDRB, 84.4% (38/45), and recorded 4.4% (2/45) strains of ESBL. Moreover, non-fermenting Gram-negative bacilli, Pasteurella pneumotropica provided 75% (3/4), as well as being the only Gram-negative bacilli species where one strain was resistant to more than three different class of tested antibiotics including carbapenems (imipenem) and was consequently named XDR with 25% (1/4). Military hospital of Douala and Emergency unit were the dominantly MDRB contaminated areas: 39.3% (22/56) and 17.9% (10/56), respectively.ConclusionsMDRB are a current public health problem and hospital surfaces are a worrying reservoir that can be spread to patients, health professionals and visitors. Our results could serve as a timely regional data of hospital surface epidemiological surveillance basis on which preventive strategy of HAIs and AMR should be built.

Clinical associations of SARS-CoV-2 viral load using the first WHO International Standard for SARS-CoV-2 RNA

SARS-CoV-2 viral load declines from the time of symptom onset; in some studies viral load is higher or persists longer in more severe COVID-19 infection, and viral load correlates with culture positivity. This was a retrospective cohort study of inpatients and outpatients during the first wave of COVID-19 infection in Western Australia, March to May 2020, of the relationship of SARS-CoV-2 viral load (using the First WHO International Standard for SARS-CoV-2 RNA) from symptom onset, by clinical subgroups determined from the public health database and hospital records, using regression analysis. We studied 320 samples from 201 COVID-19 cases: 181 mild, seven severe, 11 critical, and four cases who died (two were also critical cases). At symptom onset the mean viral load was 4.34 log10 IU/mL (3.92–4.77 log10 IU/mL 95% CI, cobas SARS-CoV-2 assay ORF1a Ct 28.9 cycles). The mean viral load change was –0.09 log10 IU/mL/day (–0.12 to –0.06 95% CI). R2 was 0.08 and residual standard deviation 2.68 log10 IU/mL. Viral load at symptom onset was higher for those reporting fever compared to those not reporting fever. Viral load kinetics were not different for gender, age, shortness of breath, or those requiring oxygen. Mean viral load at usual release from isolation at 14 days was 2.5 log10 IU/mL or day 20 was 1.8 log10 IU/mL. Variability in respiratory sample SARS-CoV-2 viral load kinetics suggests viral loads will only have a role supporting clinical decision making, and an uncertain role for prognostication.

Trend of Chickenpox in Jordan (2013-2020)

Background Chickenpox is the primary infection of varicella-zoster virus (VZV), which is a highly contagious disease. Objective The main goal of this epidemiological descriptive study was to analyze the medical chickenpox data from 2013 to 2020 in Jordan. The aim of the study was to obtain in-depth statistics for all Jordan cities comparing the year semesters for these years, with comparisons of gender and age categories. In addition, we aimed to determine the status of the epidemiological situation in Jordan with concern of the effects of Syrian refugees and the COVID-19 epidemic. Methods This was an epidemiological descriptive study focusing on children under 15 years old. Data were collected based on a clinical diagnosis by doctors. Chickenpox data were obtained from the Ministry of Health as computerized and manual weekly reports from public and private health centers and hospitals. SPSS was used to statistically analyze the data. Results The total number of chickenpox cases reported from 2013 to 2020 in Jordan was 40,988. There was an obvious rise in cases in 2014 (19.24%) with possible outbreaks due to the influx of Syrian refugees, whereas the lowest number of cases (2.44%) was reported in 2020 due to the COVID-19 pandemic and associated quarantine that occurred in Jordan, especially because of closing schools and clinics. Although the total number of chickenpox cases varied from 2013 to 2020, all years showed the same seasonal distribution, with the highest numbers in the spring (especially May), at 16.12%. Geographic distribution analysis showed that the highest numbers of cases were reported in the cities of Amman and Zarqa, with 18.15% and 12.81%, respectively, according to the highest population and gatherings. In gender distribution, there was a sustained preponderance for males over females with 54.48% of the cases reported in males. The age category of 5-9 years was the most likely to be affected by this disease, accounting for 43.34% of cases. This is because these younger children are newly entering school and starting to interact with others. However, the age category of over 20 years showed the lowest number of cases, accounting for 3.98%. There is more concern in Mafraq city (which has the greatest number of Syrian refugees), and we found that children in the age categories of 1-4 years and less than 1 year were more likely to be infected than others. Conclusions Our analysis showed a possible outbreak of chickenpox in 2014, and the lowest number of cases occurred in 2020. In addition, the spring season is the time with the highest number of infected cases. Chickenpox is a highly transmissible childhood disease that becomes more severe with age, and is especially prevalent in children 5-9 years of age in Jordan. Moreover, the gender distribution of cases throughout the years showed a sustained preponderance for males over females. Due to the high populations in Amman and Zarqa cities, these areas had the highest numbers of people infected with chickenpox.

Real-time pandemic surveillance using hospital admissions and mobility data

Forecasting the burden of COVID-19 has been impeded by limitations in data, with case reporting biased by testing practices, death counts lagging far behind infections, and hospital census reflecting time-varying patient access, admission criteria, and demographics. Here, we show that hospital admissions coupled with mobility data can reliably predict severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission rates and healthcare demand. Using a forecasting model that has guided mitigation policies in Austin, TX, we estimate that the local reproduction number had an initial 7-d average of 5.8 (95% credible interval [CrI]: 3.6 to 7.9) and reached a low of 0.65 (95% CrI: 0.52 to 0.77) after the summer 2020 surge. Estimated case detection rates ranged from 17.2% (95% CrI: 11.8 to 22.1%) at the outset to a high of 70% (95% CrI: 64 to 80%) in January 2021, and infection prevalence remained above 0.1% between April 2020 and March 1, 2021, peaking at 0.8% (0.7-0.9%) in early January 2021. As precautionary behaviors increased safety in public spaces, the relationship between mobility and transmission weakened. We estimate that mobility-associated transmission was 62% (95% CrI: 52 to 68%) lower in February 2021 compared to March 2020. In a retrospective comparison, the 95% CrIs of our 1, 2, and 3 wk ahead forecasts contained 93.6%, 89.9%, and 87.7% of reported data, respectively. Developed by a task force including scientists, public health officials, policy makers, and hospital executives, this model can reliably project COVID-19 healthcare needs in US cities.

Exploring the nexus of equality and efficiency in healthcare

PurposeThis study aims to explore the nexus of equality and efficiency by considering public hospitals' development dynamics, capacity and technology indicators.Design/methodology/approachData was collected from the Ministry of Health Public Hospital Almanacs from 2014 to 2017. The Gini index (GI) is used to estimate the inequality of distribution of hospital performance indicators. A bias-corrected efficiency analysis is calculated to obtain efficiency scores of public hospitals for the year 2017. A path analysis is then constructed to better identify patterns of causation among a set of development, equality and efficiency variables.FindingsA redefined path model highlights that development dynamics, equality and efficiency are causally related and health technology (path coefficient = 0.57; t = 19.07; p < 0.01) and health services utilization (path coefficient = 0.24; t = 8; p < 0.01) effects public hospital efficiency. The final path model fit well (X2/df = 50.99/8 = 6; RMSEA = 0.089; NFI = 0.95; CFI = 0.96; GFI = 0.98; AGFI = 0.94). Study findings indicate high inequalities in distribution of health technologies (GI > 0.85), number of surgical operations (GI > 0.70) and number of inpatients (GI > 0.60) among public hospitals for the years 2014–2017.Originality/valueStudy results highlight that, hospital managers should prioritize equal distribution of health technology and health services utilization indicators to better orchestrate equity-efficiency trade-off in their operations.

Employee Development, Retention, Motivation and Quality Service Delivery in Public Health Hospitals of South Sudan

The study was employee development, retention, motivation and quality services delivery in public health Hospital South Sudan. Therefore, the objectives of the study were to examine the relationship between Employee development and quality services delivery, assess the relationship between employees’ developments, employee Retention and quality services delivery, examine the relationship between motivations, employee retention and quality health services delivery and factor structure of Employees’ developments, Motivation, retention, and quality services delivery? The research design was cross sectional and descriptive; using both quantitative and qualitative approach, study population 1566 people, the sampling technique were simple random and stratification random was used to select the sample of 354 respondents’ staff and beneficiary, data was analysis using SPSS version (21.0) and was presented using Spearman correlation coefficient, regression, ANOVA of variance, and factor analysis structure loading to predicted the variables relationship. The tools were closed end structure questionnaires and interviewed guide. The finding shows that there is a significant positive relationship between employee development and quality services delivery (r = 0.558, p-value &lt;0.01) retention and quality services delivery (r=0.671, p-value &lt;0.01), motivation and quality services delivery (r=0.811, p- value &lt;0.01). The regression shows that the relationship between employee developments, retention, motivation and quality services delivery (F= 229.897, sig=0.000) employee development retention and motivation extremely explain quality services delivery. Motivation ( β =0.590 ) explained that change in motivation increase quality services delivery by 59%, employee retention ( β =0.243) change in retention will increase quality of services by 24.3% and employee development ( β =0.49 ) change in employee development will increase of quality services delivery by 4.9%. The study recommended that, the Ministry of health should invest more resource on employee development; retention and motivation because the play significant roles which led to quality services by improving access of the quality services to citizens. The study recommended further study on mentoring, delegation and role of reward of quality services delivery in public Hospitals. The study was employee development, retention, motivation and quality services delivery in public health Hospital South Sudan. Therefore, the objectives of the study were to examine the relationship between Employee development and quality services delivery, assess the relationship between employees’ developments, employee Retention and quality services delivery, examine the relationship between motivations, employee retention and quality health services delivery and factor structure of Employees’ developments, Motivation, retention, and quality services delivery? The research design was cross sectional and descriptive; using both quantitative and qualitative approach, study population 1566 people, the sampling technique were simple random and stratification random was used to select the sample of 354 respondents’ staff and beneficiary, data was analysis using SPSS version (21.0) and was presented using Spearman correlation coefficient, regression, ANOVA of variance, and factor analysis structure loading to predicted the variables relationship. The tools were closed end structure questionnaires and interviewed guide. The finding shows that there is a significant positive relationship between employee development and quality services delivery (r = 0.558, p-value &lt;0.01) retention and quality services delivery (r=0.671, p-value &lt;0.01), motivation and quality services delivery (r=0.811, p- value &lt;0.01). The regression shows that the relationship between employee developments, retention, motivation and quality services delivery (F= 229.897, sig=0.000) employee development retention and motivation extremely explain quality services delivery. Motivation ( β =0.590 ) explained that change in motivation increase quality services delivery by 59%, employee retention ( β =0.243) change in retention will increase quality of services by 24.3% and employee development ( β =0.49 ) change in employee development will increase of quality services delivery by 4.9%. The study recommended that, the Ministry of health should invest more resource on employee development; retention and motivation because the play significant roles which led to quality services by improving access of the quality services to citizens. The study recommended further study on mentoring, delegation and role of reward of quality services delivery in public Hospitals.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa.

BackgroundNeonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation).AimThe aim of the study was to explore neonatologists’ views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers.SettingThe setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape.MethodA qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used.ResultsThe themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governanceConclusionThe study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates.ContributionThe findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Fertility desire of HIV-positive men and women in public health hospitals.

Objective:Despite the increased emphasis on antiretroviral therapy and other healthcare services for HIV-infected individuals, issues of fertility desire have received relatively little attention. In particular, little is known about actual fertility desire and determinants of fertility desires among HIV-infected women and men receiving antiretroviral therapy.Methods:A cross-sectional study was conducted among HIV-positive individuals in public health hospitals of Addis Ababa City from 1 October to 30 November 2021. A pretested structured questionnaire was used to collect the data with a consecutive sampling technique. EpiData 4.6.2 and SPSS 25 were used for data entry and analysis. Bivariate and multivariable logistic regression analyses were done to identify factors associated with fertility desire. An adjusted odds ratio with a 95% confidence interval was computed for data interpretation. A p value of ⩽0.05 was considered to be statistically significant.Result:Among 400 participants, 55% (95% confidence interval = 50%, 60%) have future fertility desire. Factors like age less than 35 years (adjusted odds ratio = 24.03, 95% confidence interval = 9.99, 57.83), a secondary education level (adjusted odds ratio = 2.78, 95% confidence interval = 1.21, 6.40), being married (adjusted odds ratio = 2.89, 95% confidence interval = 1.39, 5.99), being employed (adjusted odds ratio = 3.12, 95% confidence interval = 1.56, 6.24), being diagnosed with HIV in the past 1 year (adjusted odds ratio = 4.02, 95% confidence interval 2.07, 7.80) or past 2–4 years (adjusted odds ratio = 9.80, 95% confidence interval = 3.89, 26.02) have a significant association with future fertility desire. Respondents using contraceptives were 90.9% less likely to have future fertility desire (adjusted odds ratio = 0.09, 95% confidence interval = 0.05, 0.18).Conclusion:The magnitude of future fertility desire was founded high. Further research on this topic should include qualitative studies to provide a deeper understanding of people living with HIV fertility desires.

Clinical Profile of COVID-19 Patients in Nangarhar University Teaching Hospital

Background: The coronavirus COVID-19, causing severe acute respiratory syndrome and patients’ mortality in considerable proportion, has affected 220 countries. There was no description of the clinical profiles such as demography (sex, age), and co-morbidities of COVID-19 patients in Eastern Region of Afghanistan, comprising Nangarhar, Nuristan, Kunar, and Laghman provinces. A vast majority of patients from these areas refer to Nangarhar University Teaching Hospital for health issues. Therefore, the researchers compiled a descriptive profile of the patients from this particular area. Materials and Methods: It was a descriptive record based study of Medical Ward, Nangarhar University Teaching Hospital. The number of profiled patients was 50, with age over 18 years old. The patient's samples were sent to Nangarhar Public Health Hospital for confirmation in Real-Time Reverse Transcriptase Polymerase Chain Reaction Assay for SARS-CoV-2 examination. Findings: Out of 50 COVID-19 affected patients, 68% were females and 32% were males. The mean age was (53±17). According to the clinical profiles, 8% had no symptoms and most common ones were fever (80%), cough (60%) and dyspnea (10%). The major comorbidities were respiratory disease (56%), hypertension (38%), Diabetes Mellitus (16%), Heart Failure (12%), obesity (10%) and chronic kidney disease (4%). Conclusion: The study concluded that the event was more common in females and aged persons than males and young patients. Fever was obviously common among all the identified patients. COVID-19 was severe in patients with respiratory diseases and hypertension.

Assessment of Obstetric Evacuations: Received during the Year 2020 at the Touba Ndamatou Public Health Hospital Establishment

The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.

Patient Perceptions about the Quality of Hospital Services in Klaten Regency during the Covid-19 Pandemic

This study aims to test service satisfaction at three public hospital health institutions in Klaten Regency during the Covid-19 pandemic, through testing the gap in the level of serv-qual achievement and patient perceptions in relation to the quality of services provided. The research method was carried out through a quantitative test of the sample as respondents as many as 110 patients through purposive sampling technique. Quantitative tests carried out in this study include validity test, questionnaire item reliability test and servqual confirmation test. The results of the research explain that all dimensions in Servqual including physical evidence, reliability, assurance, responsiveness and empathy, all of which still have a gap value with an average value of -77.27 points, which means that the patient is not satisfied. The responsiveness dimension of the quantitative test has the largest gap value of – 115.50 points so it must be a priority for three hospital institutions in improving servqual.

SISTEM INFORMASI GEOGRAFIS SEBARAN PENYAKIT TUBERKULOSIS DI KECAMATAN PANINGGARAN KABUPATEN PEKALONGAN BERBASIS ANDROID

Tuberculosis is an infectious disease that can infect one person to another caused by the bacterium Mycobacterium tuberculosis. This disease is not only transmitted to people of productive age (15-45), but teenagers or children under 15 years can also be infected with the bacteria. Every year new cases are found in Indonesia, such as in the work area of the Paninggaran Health Center, Paninggaran District. Public Health Centers and Hospitals are health facilities for the community that have the facilities and infrastructure to determine how large the coverage of health figures for the community is. From this analysis, it can be found the obstacles that must be faced, namely how to provide information to the public about the spread of Tuberculosis in Paninggaran District. This is what underlies this research to create an Android-based Geographic Information System application for the distribution of tuberculosis in Paninggaran District with menus that are useful for the wider community and easy to use. The method used in this research is the Waterfall Method. The final result of this study is a "Geographical Information System for the Distribution of Tuberculosis in Paninggaran District" in the form of an android application for the community and a website for admins, namely Paninggaran Health Center officers, so that it can facilitate the distribution of information about Tuberculosis to the community and related health services, this application can also displays a map of the distribution of Tuberculosis disease, the location of where Tuberculosis patients live, the number of Tuberculosis case data and educational news about Tuberculosis disease.