Public Health Facilities Research Articles

Evaluation of emergency nurses’ knowledge of medical response in nuclear and radiological emergencies : a cross-sectional study

BackgroundEvaluating emergency room nurses’ knowledge of radiation protection, health effects, and decontamination procedures is crucial for preparedness in nuclear and radiological emergencies. This study aims to evaluate the level of knowledge among emergency nurses in Saudi Arabia regarding medical responses to nuclear and radiological emergencies.MethodsA multicenter cross-sectional study was conducted via a self-structured questionnaire with 15 true‒false questions divided into three domains, namely, radiation protection measures, radiation health effects, and decontamination procedures, each with five items and a possible score of 1 point per correct answer. The collected data were analyzed via descriptive and inferential statistics. The study followed the STROBE checklist for methodological rigor.ResultsA total of 594 emergency nurses participated in this study, with the majority being young (64.50% aged ≤ 30), female (68.69%), bachelor’s degree-holding (67.68%), single (63.64%), having ≤ 4 years of experience (56.06%), working in public health facilities (88.89%), and lacking training in medical response (85.35%). The mean knowledge scores for participants were highest for radiation exposure effects (3.27 ± 0.91), followed by radiation protective measures (2.32 ± 0.99), and lowest for decontamination procedures (1.46 ± 1.07). Overall knowledge was measured at a mean score of 7.06 ± 1.68, with 97.47% of the nurses categorized as having poor knowledge level. Nurses in private hospitals scored higher (7.77 ± 1.82) than those in public hospitals (6.97 ± 1.65) on overall mean knowledge (P = 0.034). Concerning findings include emergency nurses’ misconceptions about the protection provided by dense materials, the effectiveness of increasing distance from a radiation source, and prioritizing decontamination of victims over life-saving measures. Additionally, they were unaware of the immediate symptoms following radiation exposure and misunderstood that the primary threat in a radioactive bomb event is the explosion rather than the radiation itself.ConclusionThis study revealed poor knowledge among emergency nurses regarding medical responses to radiation emergencies and highlighted the critical need for enhanced and standardized training in radiation emergency preparedness among nurses. The gaps in knowledge identified in this study could significantly impact the effectiveness of healthcare responses in radiation emergency scenarios. Therefore, targeted educational interventions and policy changes are recommended to address these shortcomings.

Teenage pregnancy in rural Ethiopia : The case of Jima Arjo District, East Wallaga, Western Ethiopia

ABSTRACT Background : Teenage pregnancy is a major public health concern in developing nations like Ethiopia. Many psychological, financial, and health problems are associated with it. Objective : To determine the magnitude and associated factors of teenage pregnancy among teenagers visiting public health facilities in Jima Arjo district, East wallaga, Western Ethiopia, 2022. Methods: A facility-based cross-sectional study was conducted on 421 teenage females(10 to 19 years) in Jima Arjo District from February 15 to May 30, 2022. Data were collected , cleaned and analayzed using Epidata version 3.1. Level of significance of association was determined at a P- value?<?0.05. Results: In this study, the magnitude of teenage pregnancy was 17.1%. Married participants, attending secondary school, no awareness on family planning, not living with parents, and having a sister with the history of teenage pregnancy were significantly associated with teenage pregnancy. Conclusion: This study found that the magnitude of teenage pregnancy was high. Key stakeholders should work on prevention of early marriage, raise awareness on family planning, and encourage females’ education. Keywords: magnitude, associated factors, teenage pregnancy, Jima Arjo, East Wallaga

Exploration of Iron deficiency Anemia and its associated factors among pregnant women seeking antenatal care in public health facilities of southwestern Ethiopia. A mixed study.

Background: Anemia is a major problem in Ethiopia, affecting a large part of the population. Despite the importance of the problem, the causes of anemia, especially iron deficiency anemia, among pregnant women attending antenatal care (ANC) in the study area have been little studied. Therefore, the aim of this study was to investigate iron deficiency anemia and its associated factors in pregnant women seeking antenatal care in public health facilities in Southwest Ethiopia in 2023. Methods and Materialsa mixed facility-based cross-sectional study was conducted involving 364 pregnant women from selected health facilities in Ilubabor and Buno Bedele zones. Backward multiple logistic regression was used to analyze the relationship between dependent and independent variables, with statistical significance set at a P value less than 0.05. ResultsIn this study, the prevalence of iron deficiency anemia was found to be 21.4%. Several factors have been significantly associated with iron deficiency anemia including; presence of malaria parasite [AOR= 15.8, CI = 5.1–48.4], presence of Helminthes [AOR= 8.1, CI=2.8–23.9], consumption of leafy vegetables less than once a day [AOR = 3.4, CI = 1.5-13.3] and not taking iron supplements/consumption [AOR= 2.2, CI = 1.1 to 4.4]. Conclusion and RecommendationsThe overall prevalence of iron deficiency anemia in the study area suggests that, it is a moderate public health problem. In order to improve the nutritional status of women, routine and consistent nutritional advice, the establishment of regular preventive systems and the implementation of feedback mechanisms are recommended.

Factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda: a community based cross-sectional study

BackgroundUtilization of oral health services is a global public health challenge. Low- and middle-income countries are disproportionately affected. Uganda is one of the low- and middle-income countries where only 4% of the population has access to oral health services. Northern Uganda is one of the regions in the country with limited information about oral health utilization.ObjectiveTo assess factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda.MethodsThis was a quantitative cross-sectional study conducted in Lira District. Multistage sampling was used to select 576 respondents. Data was collected using a researcher-administered structured questionnaire that was adopted, modified, and pretested. Data was analyzed at three levels, including univariate, bivariate, and multivariate at 0.05 significance level.ResultsOf the 634 respondents, 576 responded, giving a 90.9% response rate. Results show that utilization of oral health services was 20.5% (118) among adults aged 18–70 years in 6 months. Predictors of utilization of oral services among this age group are: having not attended any formal education (AOR = 0.2, 95%CI 0.06–0.62), having poor attitudes towards oral health services (AOR = 0.55, 95%CI 0.34–0.89), having cultural influence on the utilization of the oral health services (AOR = 4.84, 95% CI 2.77–8.43), accessing the services from private not-for-profit facilities (AOR = 4.67, 95% CI 1.79–12.16), being un sure of the availability of the equipment used (AOR = 0.42, 95% CI 0.18–0.9), and availability of friendly services (AOR = 2.53, 95% CI 1.12–5.50).Conclusions and recommendationsUtilization of oral health services is low in Lira district, with only 2 in 10 of the adults aged 18-70years of age utilizing oral health services in 6 months. To improve utilization, targeted health education campaigns should address cultural barriers and attitudes, while ensuring that public health facilities are better equipped and provide more user-friendly services.

HIV seropositive disclosure and associated factors among adult HIV positive clients in public health facilities in East Wollega Zone, Oromia Regional State, Western Ethiopia.

Disclosure of HIV-seropositive is important for HIV prevention and maintenance of health for people living with HIV and the community at large. Although HIV seropositive disclosure is mandatory for access to care and treatment, there is a paucity of data in the study setting. This study aimed to assess the magnitude of HIV Sero Positive Disclosure and associated factors among adult HIV positive clients in public health facilities in the east wollega zone, Oromia Regional State, Western Ethiopia, in 2023. A facility-based cross-sectional study design was conducted among 250 adult HIV-positive clients in public health facilities in East Wollega Zone. Systematic sampling was used to select the study participants. Data were collected from February 1 to April 15, 2023, using a structured, pretested, interviewer-administered questionnaire and reviewing patient cards using a checklist. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analyses were done. In bivariable analyses, variables with a P-value <0.25 were candidates for the multivariable model; in the multivariable model, significant associations were declared at a P-value < 0.05 and reported by an adjusted odds ratio along with a 95% confidence interval. The magnitude of HIV seropositive disclosure to at least one person was found to be 68.2% (95%CI = 62.5%, 73.9%). HIV seropositive disclosure was significantly associated with being married ((AOR = 5.47, 95%CI: 2.87-10.43), low knowledge level (AOR = 0.095, 95% CI = 0.017-0.54), and perceived community discrimination (AOR = 0.192, 95% CI = 0.050, 0.74). This study reveals that HIV seropositive disclosure was low among the adult population living in the study area as compared to the other study findings. Disclosure of seropositives was significantly associated with marital status, knowledge level about the importance of disclosure, and perceived discrimination in societies. Healthcare providers and HIV prevention programme planners should provide health education about the importance of HIV disclosure and the stigma against HIV-positive patients by increasing society's awareness through appropriate channels.

Effect of the second and third COVID-19 pandemic waves on routine outpatient malaria indicators and case management practices in Uganda: an interrupted time series analysis

BackgroundReports on the impact of COVID-19 pandemic on the quality of malaria care and burden in sub Saharan Africa have provided a mixed picture to date. The impact of the 2nd (Delta) and 3rd (Omicron) COVID-19 waves on outpatient malaria indicators and case management practices was assessed at three public health facilities with varying malaria transmission intensities in Uganda.MethodsIndividual level data from all patients presenting to the out-patient departments (OPD) of the three facilities (Kasambya, Walukuba and Lumino) between January 2019 and February 2022 were included in the analysis. Outcomes of interest included total number of outpatient (OPD) visits, proportion of patients suspected to have malaria, proportion of suspected malaria cases tested with a malaria diagnostic test, test positivity rates (TPR) and proportion of malaria cases prescribed artemether-lumefantrine (AL). Using the pre-COVID-19 trends between January 2019 and February 2020, interrupted time series analysis was used to predict the expected trends for these study outcomes during the 2nd wave (May 2021–August 2021) and 3rd wave (November 2021–February 2022). The observed trends of the study outcomes were compared with the expected trends.ResultsThere were no significant differences between the observed versus expected overall outpatient visits in the 2nd wave, however, a significant decline in OPD attendance was observed during the 3rd wave (15,101 vs 31,154; incidence rate ratio (IRR) = 0.48 [0.41–0.56]). No significant differences in the overall observed versus expected proportions of suspected malaria cases and test positivity rates in both COVID waves. However, a significant decrease in the overall proportion of suspected malaria cases tested with a malaria diagnostic test was observed during the 3rd wave (99.86% vs 99.99%; relative percent ratio [RPR] = 0.99 [0.99–0.99]). Finally, a significant decline in the overall proportion of malaria cases prescribed AL was observed during the 2nd wave (94.99% vs 99.85%; RPR = 0.95 [0.92–0.98]) but not the 3rd wave.ConclusionSignificant declines in OPD attendance and suspected malaria cases tested with malaria diagnostic test were observed during the 3rd COVID-19 wave, while AL prescription significantly reduced during the 2nd COVID-19 wave. These findings add to the body of knowledge highlighting the adverse impact of COVID-19 pandemic on the malaria which could explain the increase in the malaria burden observed during this period.

Women living in the region under an emergency command post are experiencing delays in reaching health facilities: a multi-center cross-sectional study

IntroductionThe time between seeking emergency care and receiving the first healthcare service is referred to as delays in reaching health facilities. Delay in reaching health facilities had three main sub-themes in different studies. These include (i). Availability of transportation and infrastructure, (ii). Distance from health facilities and (iii). Lack of finance for transportation. Although there are plenty of findings about maternal delays in reaching health facilities, studies do not address the delay situation of women in conflict zones all over the world. In Ethiopia, specifically, we saw women delayed in healthcare service due to restricted movement and closure of roads, even for ambulances, at night time. MethodsA multi-center cross-sectional study was conducted among mothers attending public health facilities in the south Gondar zone, Ethiopia from September 01/2023 to April 30/2024. The data was collected by four BSc degree-holder midwives, using structured questionnaires after training was given for a day in each hospital. A pretest using 5% of the sample size was conducted. Descriptive statistics, and multivariable logistic regression analyses were used to identify factors associated with delays in reaching health facilities. Variables having p-value ≤ 0.2 in the bi-variable analysis were fitted into multiple logistic regression models.Result The prevalence of delay in reaching health facilities among women who are living in the region of emergency command post was 54.9% CI (42.04-59.87%). Living in rural areas, non-availability of public transport during the armed conflict, labor onset at nighttime, road closures by the armed forces, and non-availability of ambulances were the factors that contributed to the delay during the emergency command post. ConclusionThe magnitude of delay in reaching health facilities among women who are living in the region of emergency command post was high.

Monitoring the digital healthcare transition in Italy: Initiatives, metrics and feedback from Primary Care Physicians

Abstract Italy’s healthcare sector has undergone significant digital transformation since 2008, driven by national strategies and reforms overseen by the Ministry of Health, the Ministry of Economy and Finance, and the Agency for Digital Italy. Key initiatives include the establishment of centralized booking systems, electronic health records (EHR), ePrescription, dematerialization of medical reports and disease certificates, patient summary, and telemedicine services. Despite regional variations, progress in the EHR adoption has been notable. Ongoing investments under the 2021 National Recovery Plan aim to further enhance digital healthcare infrastructure by 2025 through the involvement of the Italian National Agency for Regional Healthcare Services (AGENAS). Currently, Italy monitors progress through comprehensive measurement frameworks tracking digital health initiatives’ implementation and impact. These encompass indicators reported quarterly by public healthcare facilities regarding the implementation of patient portals, regional registries, network infrastructure, regional EHR systems (i.e., n° of users), and digital laboratory reports. In parallel, we conducted a cross-sectional survey assessing knowledge, opinions and concerns among primary care physicians (PCPs) following the 2022 reform, which introduced Community Hospitals, Community Houses, and telemedicine in primary care. The survey highlighted mixed opinions and insufficient knowledge among PCPs regarding the novelties. Clearer communication and coordination with territorial services appears necessary. Many GPs are engaging in telemedicine, but digital literacy gaps remain, as only 35.7% believed they had necessary digital literacy. This is an insight into Italy’s digital health roadmap, mainly involving primary care and focusing on achievements, challenges, and future prospects in utilizing digital solutions across healthcare settings.

Time to viral load suppression and its predictors among people living with HIV on antiretroviral therapy in Gebi Resu zone, Afar Region, Ethiopia, 2023

ObjectiveThis study aimed to estimate the time to viral load suppression and identify its predictors among HIV patients receiving antiretroviral therapy (ART) in the Gebi Resu zone, Afar Region, Ethiopia, 2023.SettingThe study was conducted at public health facilities in the Gebi Resu zone of the Afar region.Study designThis study is a facility-based, retrospective follow-up study.Study participantsThis study included 298 people living with HIV who were receiving ART services at selected health facilities in the Gebi Resu zone. Data were collected by reviewing patient records using a structured checklist. Bivariate and multivariate Cox regression analyses were conducted to assess the relationship between variables and control for confounders.ResultsThe incidence rate of viral load suppression was 9.46 per 100 person-months. The median time to viral load suppression was 7.7 months, with an interquartile range of 3.8 months (IQR = 6.47–10.27). Patients at clinical stages 3 and 4 [AHR = 0.67, 95%CI (0.47, 0.96)], those who received cotrimoxazole prophylaxis therapy [AHR = 1.47, 95%CI (1.12, 1.92)], and patients with poor drug adherence [AHR = 0.40, 95%CI (0.18, 0.90)] were significantly associated with time to viral load suppression among people on antiretroviral therapy.ConclusionThe time to viral load suppression and the median time to viral load suppression among people living with HIV on ART were shorter than those observed in many developing and developed countries. Clinical stage, cotrimoxazole prophylaxis therapy, and drug adherence were significant predictors of viral load suppression.

Exploring the associations of tobacco smoking and serum cotinine levels with selected inflammatory markers in adults with HIV in South Africa

This study examined the associations between tobacco smoking and serum cotinine levels, an objective biochemical measure of tobacco smoke exposure, with markers of inflammation, i.e., interferon-gamma (IFN-γ), interleukin 10 (IL-10), interleukin 2 (IL-2) and tumour necrosis factor-alpha (TNF-α) in people living with HIV (PLWH).These specific markers were selected because of their hypothesised associations with smoking, PLWH and their outcomes. In a random sample of ≥ 18-year-old PLWH receiving care at 17 public healthcare facilities across the Western Cape Province in South Africa, data collection included self-reported smoking history, and serum levels of cotinine and selected inflammatory markers. The inflammatory marker data were log transformed because of the skewedness of their distribution. Linear regression models (1) adjusted for age and gender, and (2) fully adjusted for age, gender, current alcohol use, body mass index and CD4 counts were used to examine the associations between smoking tobacco or serum cotinine and inflammatory markers. Level of significance was p < 0.05. Among 749 PLWH who were mainly women (79%), the mean age was 38.5 (8.9) years and similar when stratified by smoking status. Serum cotinine levels exhibited a striking discrepancy, with a median of 154 ng/mL among current smokers, in stark contrast to the consistent median values of 10 ng/mL observed among past and never smokers. In regression models adjusted for age and gender, current smoking and frequent smoking were associated with lower IL-2 but higher TNF-α. Log-cotinine exhibited associations with IFN-γ, IL-10, and TNF-α, while cotinine levels ≥ 10 ng/mL compared to < 10 ng/mL were associated with higher IFN-γ and TNF-α. In fully adjusted models, log-cotinine and cotinine levels ≥ 10 ng/mL displayed significant associations with higher IFN-γ and lower IL-2. This study underscores the importance of investigating the interplay between smoking tobacco or serum cotinine levels with pro-inflammatory cytokines in PLWH. It signals the need for comprehensive research to unravel the potential synergistic impacts of smoking tobacco and HIV infection on chronic inflammation and immune dysregulation, shedding light on critical avenues for intervention and management strategies.

Determinants of health-seeking behaviour in rural district of Jasikan, Ghana: a cross-sectional study

BackgroundThe Ghana Health Service aims to ensure the health of all Ghanaians. Understanding the factors that influence people’s health-seeking behaviour will help the Ghana Health Service evaluate and enact policies that will enable it to achieve set targets. This research aimed to determine the factors that influence the health-seeking behaviour of the residents of Jasikan District and ascertain the importance of the well-being clinic in this context.MethodsThe study design was a community-based cross-sectional study using a mixed method of data collection. A stratified sample of 295 respondents from the five [5] sub-districts of the target population was obtained. Cramer’s V statistic was used to assess the effect size and significance of the association between categorical variables. Further, multiple binary logistic regression was used to determine significant predictors of health-seeking behaviour. Health seeking behaviour was categorised as appropriate or inappropriate. The health seeking behaviour of participants was considered appropriate if they sought health care at public health facilities, private health facilities, and licensed Pharmacies/OTCMS and inappropriate when participants sough care at traditional/faith healers, engaging in self-medication, and not taking action during an illness episode.ResultsThe mean age of participants in the study was 37.49 ± 15.74 years. Females comprised the majority of study respondents (160; 56.3%). When they fell ill, 61% of respondents chose formal public health institutions as the first port of call. A significant proportion of respondents (245; 83%) preferred appropriate health-seeking behaviour, with age (p = 0.045) and health insurance status (p < 0.01) significantly influencing where respondents sought care. More than half of respondents indicated that affordable service (59.9%), readily available drugs (54.5%), and good services (52.0%) are key characteristics of respondents’ preference for service in healthcare. The educational level significantly correlated with service characteristics when people seek health care (p = 0.035). The severity of illness (9; 28.1%), perception of a facility as the best place (7; 21.9%), well-trained staff (4; 12.5%), and professionalism (3; 9.4%) influenced respondents’ choice of health care. More than half (78%) of respondents agreed with the need for a well-being clinic in a hospital. The binary logistic regression indicates that religion is a significant predictor the appropriateness of participants’ health seeking behaviour, but the overall model could not improve the overall prediction rate of the constant model.ConclusionThe health-seeking behaviour of the people of Jasikan is good. The participants’ sex, good service, affordability, and availability of medicines are critical service characteristics that influence the choice of healthcare providers. Managers of health facilities should consider these characteristics to remain competitive and drive positive health-seeking behaviour in the community. Facilities are encouraged to set up a functional well-being clinic and open it to the public.

Effects of Consistency in Healthcare Settings on Employee Performance in Zanzibar’s Public Health Facilities: An Analytical Study

This study investigates the impact of consistency on employee performance within Zanzibar's healthcare sector. Consistency, encompassing core values, agreement, and coordination/integration, is essential in maintaining high standards of care and ensuring alignment with organizational goals. Using a cross-sectional descriptive design and quantitative approach, data were collected from 288 healthcare employees with a minimum three-month tenure of the four selected district hospitals in Zanzibar through structured questionnaires, and responses were analysed using descriptive statistics and multiple regression analysis with the aid of IBM SPSS (Version 25). The results revealed that while consistency is a critical factor in organizational culture, its relationship with employee performance is weak and statistically insignificant. Specifically, the regression analysis indicates that an increase in consistency is associated with a slight decrease in employee performance, a finding that contrasts with previous studies. Despite this, the study identifies the importance of core values and coordination/integration as distinct constructs that contribute uniquely to organizational consistency. The study concludes that while consistency is important, its influence on employee performance may be more complex than previously understood. The findings suggest the need for targeted interventions to enhance specific aspects of consistency, such as cross-departmental coordination and management practices, to improve organizational effectiveness. Future research should focus on exploring these interventions and their impact on employee performance and patient care outcomes in healthcare settings.

Assessment of magnitude of medicines wastage and the contributing factors in selected public health facilities of Hadiya Zone, Central Ethiopia Regional State

BackgroundMedicine wastage occurs when medicines are damaged, obsolete, or expired and become unsafe for use. In Ethiopia, although there are reports that reveal the presence of wasted medicines in the country, there is limited objective evidence on the type and extent of medicine wastage as well as its contributing factors.ObjectiveThe study aimed to assess the medicine wastage rate and identify its contributing factors in the sampled public health facilities (HFs) in Hadiya Zone, Central Ethiopia Regional State.MethodA facility-based cross-sectional study complemented by a qualitative study was conducted in selected public HFs in Hadiya Zone, Central Ethiopia Regional State, from November 1 to 31, 2022. All the hospitals were selected intentionally, and health centers were selected using simple random sampling techniques. For the qualitative study, the chief clinical officers and pharmacy department heads of HFs were purposefully selected as key informants because they were supposed to be more information-rich than other health professionals. The quantitative data were entered and analyzed using the Statistical Package for Social Sciences version 20.ResultThe total monetary value of wasted medicines in the assessed HFs in the Ethiopian Fiscal Year (EFY) 2011–2013 was 652,479.45 ETB (5.24%). The three-year trend showed that, in the 2011–2012–2013 EFY, medicine wastage was 7.57%, 6.44%, and 3.1%, respectively. Expiration solely accounted for 97.3% of this total value. The alleged explanations for the waste of such medicines were a lack of accurate data available for medicine quantifications, the presence of overstocked medicines due to improper forecasting, a lack of electronic stock management, an abrupt change in the treatment regimen, and improper use of stock management. Whether the perceived causes had an impact on the medicine wastage was assessed, and the results confirmed that a significant association between medicine wastage and overstock (p-value = 0.006, AOR = 8.57, 95% CI = 1.87–39.26), accurate data (p-value = 0.013, AOR = 5.43, 95% CI = 1.42–20.76), and electronic stock management (p-value = 0.05, AOR = 0.311, 95% CI = 0.094–1.03) was observed.ConclusionThe identified medicine wastage rate is significant for a nation that struggles to allocate limited resources fairly. It may negatively affect the initiatives taken by the government to increase public engagement in the healthcare system through insurance contributions. It is a glance for HFs to take immediate corrective action.

Acceptability of six-monthly PrEP dispensing supported with interim HIV self-testing to simplify PrEP delivery in Kenya: findings from qualitative research

BackgroundIn Africa, dispensing oral HIV pre-exposure prophylaxis (PrEP) within already strained public health facilities has led to prolonged waiting periods and suboptimal experiences for clients. We sought to explore the acceptability of dispensing PrEP semiannually with interim HIV self-testing (HIVST) versus quarterly PrEP dispensing with clinic-based HIV testing to optimize clinic-delivered PrEP services.MethodsWe conducted a qualitative study within a non-inferiority individual-level randomized controlled trial testing the effect of six-monthly PrEP dispensing with HIVST compared to the standard-of-care three-monthly PrEP dispensing on PrEP clinical outcomes in Kenya (ClinicalTrials.gov: NCT03593629). Eligible participants were ≥ 18 years, refilling PrEP for the first time, and either in an HIV serodifferent relationship (men and women) or singly enrolled (women only). A subset of participants in the intervention group completed serial in-depth interviews (IDIs) at enrollment, six months, and 12 months. We utilized stratified purposive sampling to ensure representation across participant groups. We analyzed our qualitative data thematically using a combination of inductive and deductive approaches, the latter guided by the Theoretical Framework of Acceptability (TFA).ResultsBetween May 2018 and June 2021, we conducted 120 serial IDIs with 55 participants; 64% (35/55) were in a serodifferent relationship, 64% (35/55) were women, and the median age was 32 years (IQR 27–40). Overall, participants found this novel PrEP delivery model highly acceptable; it was well-liked, private (TFA construct: affective attitude), and less burdensome (TFA construct: burden) compared to standard PrEP delivery. Additionally, participants were confident in their ability to participate in the intervention (TFA construct: self-efficacy). Some participants, however, highlighted model disadvantages, including fewer opportunities for in-person counseling and potentially less accurate HIV testing (TFA construct: opportunity costs). Ultimately, most participants reported that the intervention allowed them to achieve their HIV prevention goals (TFA construct: perceived effectiveness) and that their confidence in at-home HIVST and PrEP continuation increased following each semiannual clinic visit.ConclusionsSemiannual PrEP clinic visits supported with six-monthly drug dispensing and interim HIVST was acceptable among PrEP users who experienced the intervention in Kenya. More comprehensive pre-intervention counseling and training on HIVST may help alleviate the client concerns presented, which were often resolved over time with intervention experience.

Understanding the association of disability with multimorbidity, and healthcare utilization in India's older adult population: insights from cross-sectional evidence of SAGE-2.

Like other low-and middle-income countries, India is undergoing a demographic and epidemiologic shift that has led to a significant rise in the burden of non-communicable diseases (NCDs). Evidence suggests that chronic illnesses and disability are linked but limited studies have explored the association between disability and multimorbidity (simultaneous presence of two or more chronic conditions). Since the magnitude of multimorbidity is becoming a norm, it is prudent to understand the association between these two. We aimed to estimate the association between disability and multimorbidity and assess their healthcare utilization among older adults in India using a nationally representative data. We employed data from the second round of World Health Organization's Study on Global AGEing and adult health (SAGE) conducted in 2015. SAGE is a nation-wide survey conducted among a representative sample of older adults aged ≥50 years, a total of 7,118 participants aged ≥50 years were included in the analysis. The main outcome of interest was disability for which we used WHODAS 2.0 scoring scale which ranges from 0 to 100. Descriptive statistics such as frequency and proportion were used to report the characteristics of study population, and prevalence. We performed the univariable followed by multiple ordinal logistic regression to assess the association between disability and multimorbidity, reported as adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value. Healthcare utilization was presented as frequency and proportion. The overall prevalence of disability was found to be 89.0% (95% CI: 88.3-89.8) while that of multimorbidity was 39.7% (95% CI: 35.6-37.8). Most of the participants had moderate followed by mild disability. Hypertension (32.7%) was found to be the most prevalent chronic condition followed by cataract (21.3%). The chances of having disability among multimorbid individuals was AOR: 1.40 (95% CI: 1.13-1.75). Participants having disability and multimorbidity mostly visited private sector followed by public healthcare facilities. We observed that nine out of every 10 individuals had some kind of disability in India. We observed multimorbidity to be associated with disability that signifies the need for including disabilities as a part of NCD program as these factors could be bi-directional. Longitudinal studies for disability will be helpful to better understand and address the growing needs of these individuals.

Health Facility Capacity and Health-care Worker Knowledge, Attitudes, and Practices of Hepatitis B Vaccine Birth-dose and Maternal Tetanus-Diphtheria Vaccine Administration in Nigeria: A Baseline Assessment.

Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria. This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics. The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns. The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar.

Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population. Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05. Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension. This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Key Predictors of Patient Satisfaction and Loyalty in Saudi Healthcare Facilities: A Cross-Sectional Analysis.

Patient satisfaction and loyalty are essential indicators of healthcare quality, directly impacting patient outcomes and the long-term success of healthcare facilities. Despite the growing importance of patient-centered care in Saudi Arabia, there is limited research exploring the factors that influence patient satisfaction and loyalty, particularly in the Riyadh region. This study aims to identify the key factors influencing patient satisfaction and loyalty among Saudi patients attending public and private healthcare facilities in the Riyadh region. The study focuses on how healthcare service quality, communication, and demographic factors contribute to patient satisfaction and loyalty. A cross-sectional study was conducted with a sample of 350 Saudi patients from 10 healthcare facilities in Riyadh. Data were collected using the Patient Satisfaction Questionnaire (PSQ-18) and the Patient Loyalty Questionnaire (PLQ). Descriptive statistics, Pearson correlation, and multiple linear regression were employed to identify predictors of patient satisfaction and loyalty. Significant predictors of patient satisfaction included general satisfaction (β = 0.48, p < 0.001), communication (β = 0.35, p < 0.001), and the frequency of healthcare visits (β = 0.13, p = 0.011). Private healthcare facilities had higher satisfaction (p < 0.001) and loyalty scores (p < 0.001) compared to public facilities. Patient loyalty was strongly predicted by general satisfaction (β = 0.55, p < 0.001) and communication (β = 0.42, p < 0.001). Communication quality and patient satisfaction are key drivers of patient loyalty in Saudi healthcare facilities. Private facilities outperform public ones in patient satisfaction and loyalty. These findings emphasize the need for healthcare providers to enhance communication and service quality to foster patient loyalty. Tailored approaches to meet the diverse needs of patients, particularly in terms of education and visit frequency, are crucial for improving healthcare outcomes in Saudi Arabia.

Pay for a free service, access to cesarean section in the slums of Dakar

BackgroundIn sub-Saharan Africa, equitable access to cesarean section remains a major challenge for reducing maternal and neonatal mortality, particularly among disadvantaged populations. This situation is further exacerbated in slums, where women face significant financial barriers to accessing expensive healthcare services, such as cesarean. Within this context, this paper aims to study access to emergency cesarean services among women living in the slums of Dakar, considering the free cesarean policy implemented in Senegal since 2005.MethodQuantitative data were collected using a cross-sectional retrospective approach, from 18 health facility managers and 260 women living in slums in Dakar who had undergone cesarean delivery between July and December 2022. The surveys aimed to collect socio-demographic data on women and the costs they paid to have a cesarean section, as well as on the application of the policy of free caesarean sections by public health facilities. The data were processed using Stata.ResultsThe results indicated that poor women residing in Dakar slums do have access to emergency cesarean section services in public health facilities. However, a significant portion of these women come from impoverished households and lack higher education, making them more vulnerable to financial constraints when seeking a C-section. Despite cesarean sections being performed primarily based on medical necessity, regardless of the woman's economic status, ethnicity, or educational background, women often find themselves having to pay substantial amounts to undergo the procedure. This is particularly concerning, as cesarean sections are intended to be entirely free in public health facilities in Senegal. Health facility managers attribute this financial burden to the State, which recurrently delays reimbursements for cesarean sections, forcing them to charge women higher prices for the procedure.ConclusionA more rigorous enforcement of the policy for free cesarean section could greatly enhance access to this obstetric practice for women living in the slums of Dakar.