Rural Health Facilities Research Articles

Stereotactic biopsy for brain lesions: Doing more with less.

Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis. Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion. The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded. Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.

The use of a mobile obstetric emergency system to improve obstetric referrals in Bong County, Liberia: A pre-post study.

Liberia experiences an unmet need for cesarean section with about 5% population coverage, lower than 9%-19% coverage associated with improved maternal and newborn outcomes. Delays in the referral process for comprehensive emergency obstetric and newborn care (CEmONC) services due to ineffective communication between a rural health facility (RHF) and a district hospital contribute to the low CS rate. This study examined the association between mobile obstetric emergency system (MORES) implementation and referral time for obstetric emergencies as well as maternal/newborn outcomes. A pre-post descriptive analysis was conducted on data collected from 20 rural health facilities (RHFs) and two hospitals in Bong County. Women with referral data from both RHFs and hospitals were matched and information including transfer time, reasons for referral, and maternal and newborn outcomes were extracted. Descriptive analysis and logistic regression models examined the relationship between the intervention's implementation and mode of delivery, maternal outcome, newborn outcome, and transfer time from RHF to district hospital. Ethics approval was obtained from two study centers. Women had higher odds of undergoing a CS at endline (OR: 1.86 95% CI: 0.99-3.46) compared to baseline. Additionally, newborns had lower odds of showing non-vigorous symptoms (OR: 0.31; 95% CI: 0.14-0.68), defined as a newborn with poor respiratory effort, muscle tone, or heart rate. There was no significant association between the intervention's implementation and transfer time. The MORES intervention is a promising means to increase timely care seeking along the referral pathway which may enhance access to cesarean section as well as improved newborn outcome in low- and middle-income countries.

A Spoonful of Solar to Help the Medicine go Down Exploring Synergies Between Health Care and Energy

Given the wide adoption of decentralized solar energy systems in rural health facilities, this report explores the role of decentralized solar energy interventions in rural health facilities and its linkages to provisioning of health care services, especially for underserved populations. It reviews current decentralized energy interventions across multiple Indian states under different financing, ownership, and operating modes and attempts to understand the lacunae that certain implementation models face in terms of scalability and what conditions are essential to ensure the sustainability of decentralized renewable energy (DRE) systems in rural health facilities in the long run. The report is a culmination of extensive literature review, in-person interviews, field visits to the health facilities, as well as our own experience in supporting development partners to implement decentralized solar energy solutions in India. We studied 22 health facilities that are being powered by decentralized solar energy systems in rural parts of six Indian states—i.e., Assam, Chhattisgarh, Jharkhand, Karnataka, Meghalaya, and Odisha.

Determinants of Good Glycemic Control among Individuals of Type II Diabetes Mellitus Seeking Treatment at a Rural Health-care Facility in Goa - A Cross-sectional Study.

Good glycemic control is the aim of managing type 2 diabetes mellitus (T2DM) which is crucial for the prevention of long-term complications in individuals with T2DM. The aim of this study was to identify the factors associated with good glycemic control in individuals with T2DM following up at a rural health-care facility (HCF) in Goa. A cross-sectional study was conducted among 120 individuals with T2DM who regularly followed up at a rural HCF in Goa. Participants were selected using simple random sampling. It was found that the participants belonging to the 60-89 years of age group and those on mono/dual oral therapy were more likely to have good glycemic control. Participants' glycated hemoglobin A1c decreased by 0.083% for every year of increase in age and increased by 0.044% for every centimeter increase in abdominal girth.

Empowering the LMIC hinterlands with compatible technologies for neonatal care – the resilience of a research group

Background: High neonatal mortality rate (NMR) in low- and middle-income countries (LMIC) might not be resolved until rural healthcare facilities are empowered with sustainable frugal technologies and procedures. Needed technologies may not rely on cutting-edge systems of the high-income countries (HIC), which require much funding and well-established public infrastructure to thrive. Rather, tailored non-conventional designs that are compatible with the deficiencies at low-income settings must take center stage. Study design: A multistage strategy was designed to identify and resolve the technology and knowledge gaps responsible for high NMR and rural community deficiencies militating against neonatal interventions within the primary healthcare settings in Nigeria. Methods: We concluded many scientific investigations and developed interventions over 25 years period to resolve the various factors militating against neonatal survival in Nigeria. Unconventional ideas relying on solar powered systems and easily available local materials were developed, trialed, and commissioned at various times across 31 tertiary hospitals spanning all regions of Nigeria. Stand-alone studies or solutions-creation, amidst discouraging situations, were individually completed, peer-reviewed, and journal-published. The full package of technologies was finally assembled to launch a community empowerment strategy – the Neonatal Rescue Scheme – to generate integrated proof of concept. Finding: The number of early neonatal deaths and overall NMR drastically reduced at participating centers. Conclusions: This Rescue-Scheme strategy could revolutionize neonatal healthcare in low-income countries and drastically reduce Nigeria’s corporate NMR if properly adopted. Clinical evidence: Recent studies of the Scheme and various combinations of its neonatal technologies have demonstrated significant clinical evidence of NMR-reduction, e.g., overall NMR fell from 90/’00 to 4/’00 as published by Amina-center Minna Nigeria 2023; early mortality fell from 81% to 0% - University of Abuja Teaching Hospital Nigeria 2017, etc.

Obstetric anaesthesiology: manpower and service provision issues in India

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.

Use of a digital job-aid in improving antenatal clinical protocols and quality of care in rural primary-level health facilities in Burkina Faso: a quasi-experimental evaluation

ObjectiveWe assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in...

Correlation of Risk Factors with the Severity of Diabetic Retinopathy at a Rural Health Facility in Sindh Pakistan

Diabetes Mellitus (DM) and the resulting Diabetic Retinopathy (DR) is a significant health problem around the World. In 2019, the total number of diabetics worldwide was 463 million, and 35% had some DR. Objectives: To determine the correlation between the severity of Diabetic Retinopathy (DR) and the known risk factors. Methods: Analytical cross-sectional study design was used with convenience sampling in a primary, multispecialty day care health facility under the Baqai Foundation (Khushal Nagar) in a rural area of Sindh from 2020 - 2022. A total of 133 patients had some DR according to the International Classification of Diabetic Retinopathy Severity Scale (ICDRSS), which correlated with the different risk factors. Spearman rank correlation was used, and the result was considered significant when the P value was <.05. Results: The results showed a significant positive correlation between the severity of DR with Age, Random Blood Sugar, Hypertension, and Smoking. Glycated hemoglobin and hyperlipidemia were not significantly correlated, mainly because of the small sample size. (23 and 14 respectively). The patients who tried to have Lipid Profile and Glycated Hemoglobin done had stage four or five of ICDRSS. Conclusions: Most risk factors studied were positively correlated with the severity of DR. Besides the intended study, the findings highlighted the non-awareness of patients about DR and its consequences. Awareness campaigns and screening programs for DR and its risk factors are urgently required and tailored to our circumstances.

Readiness of the Interns to work at rural area: a cross-sectional survey in a backward district of West Bengal

Background: The scarcity of qualified doctors in rural areas remains a critical challenge for the health sector in India Aim was to analyze the perception of medical students regarding upcoming compulsory rural posting for 1 year as a part of their rotatory internship Methods: A cross-sectional survey was conducted in a medical college of West Bengal among the interns during March 2019 to February 2020. By doing complete enumeration of the interns present at the end of their Community Medicine posting, the sample size became 125. Predesigned, semi structured questionnaire was used for data collection. At the end of community medicine posting, when the interns came to department for completion, the printed questionnaire were given to them for filled up by their own. Collected data were entered in MS excel spreadsheet and analyzed with the help of SPSS 22.0 version. Results: About 74% interns thought it was difficult to serve the rural areas however 52% felt it will enrich their professional skills and about 65% thought it would be beneficial to the rural community. Only 22.4% were in favour of rural posting during their internship and 46% thought paying bond money is a good way out. Lengthening of MBBS course, inadequate clinical exposure, poor connectivity, no job satisfaction, obstructed career growth, no quality of life, insecure working environment for women, excessive workload, inadequate monetary compensation were the major reasons identified by interns for noncompliance of compulsory rural service during internship. Conclusions: The policymakers and medical educators need to design newer strategies for the improvement of rural healthcare facility keeping in mind the perception of students regarding rural service in the present scenario.

Determinants of maternal length of stay following childbirth in a rural health facility in Eritrea

BackgroundThe days following childbirth are a critical phase in the lives of mothers and newborns. Postpartum length of stay is a critical indicator of the efficiency of health care delivery. This study aims to explore maternal length of hospital stay (LOS) following childbirth and associated factors in a rural health facility in Eritrea.MethodologyA retrospective study of all mothers who delivered at Nakfa Hospital between 2020 and 2022 was conducted. Sociodemographic, past obstetric, and neonatal factors associated with postpartum LOS were evaluated for both vaginal delivery (VD) and cesarean delivery (CD). The determinants of LOS following VD were explored using negative binomial regression.ResultsA total of 2025 mothers [1975 (97.5%) VD and 50 (2.5%) CD] were included in the study. The median LOS following childbirth was 1 (IQR: 0–1) day for VD and 6 (IQR: 4–8) days for CD. A substantial proportion of mothers were found to have inadequate stays following VD [29% (95% CI: 27–31)], whereas 68% (95% CI: 54-81%) stayed for > 4 days following CD. In this study, VD that were attended by physicians had no inadequate stay, whereas 27.4% of deliveries attended by midwives and 31.3% by associate nurses resulted in inadequate stay (P-value < 0.001). Determinants of LOS following VD were: the presence of maternal complications (IRR = 2.8, 95% CI: 1.6-5, p-value < 0.001), delivery years 2020 and 2021 (IRR = 1.5, 95% CI: 1.2–1.8, p-value < 0.001 and IRR = 1.4, 95% CI: 1.2–1.7, p-value < 0.001, respectively), and delivery hour interval 23:00–7:00 (IRR = 0.8, 95% CI: 0.7–0.9, p-value = 0.03).ConclusionA substantial proportion of mothers stay too short post-VD to allow adequate postnatal care, which can have untoward consequences for maternal and child health. Going forward, improved coverage of antenatal care for early diagnosis of maternal complications in pregnancy as well as assessing the level of knowledge and provisions of training and refresher courses for birth attendants should be worked upon. In addition, efforts to conduct studies that explore maternal and health care provider perspectives on LOS should be emphasized.

Linking quality supervisory support to turnover intentions among rural healthcare professionals: The mediating role of performance appraisal satisfaction and moderating role of perceived organizational support

This study examines the relationships among quality supervision, performance appraisal satisfaction, and employee turnover. It explores the moderating role of perceived organizational support in these relationships within the context of rural healthcare. Data for this study were obtained from an online survey of employees from a large rural health facility in the Southeastern United States. Hypothesized relationships were examined using regression-based moderated mediation analysis. The empirical results suggest a negative relationship between the quality of supervisory support and turnover intentions, mediated partially by employees’ performance appraisal satisfaction. The indirect effect of quality supervisory support on turnover intention and the direct effect of performance appraisal satisfaction on turnover were also found to be moderated by perceived organizational support. Understanding factors that drive employee retention can help inform effective managerial practices and interventions for reducing turnover. Our study contributes to practice and the existing literature by examining the boundary conditions of perceived organizational support on the direct and indirect association between quality supervisory support and turnover intentions via performance appraisal satisfaction.

Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial.

The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women's satisfaction, women's knowledge on birth preparedness and complication readiness, maternal and child health service use, men's involvement in maternal health service utilization, and women's contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374. DERR1-10.2196/37136.

Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study.

This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.

Capacity of Clinical Officers to Care for Patients with Hypertension and Type 2 Diabetes Mellitus in Rural Healthcare Facilities in Kisumu County, Kenya

This study aimed to investigate the ability of clinical staff in a rural Kenyan health facility to manage patients with hypertension and type 2 diabetes mellitus. The study involved 146 clinicians from 56 medical facilities who were interviewed using semi-structured questionnaires, simulations, and observational instruments. Descriptive analysis was performed using SPSS version 24. Results showed that lack of knowledge of risk factors for HTN&amp;amp; T2DMHTN &amp;amp; T2DM, inability to perform a complete physical examination, inability to identify first-line medications for either hypertension or type 2 diabetes mellitus, unavailability of assigned patient follow-up clinic day/staff/room, and lack of treatment guidelines for hypertension and diabetes were associated with an inability to manage such patients. However, concurrent prescription of anti-hypertension medication along with advice on lifestyle modification strategies was associated with an ability to do so (OR 0.079; 95% CI0.016-0.934; P=P = 0.002). The study recommends that clinical staff receive education on the risk factors, physical examination, and first-line medications for managing hypertension and type 2 diabetes mellitus. Additionally, the study highlights the importance of having scheduled clinic days, assigned staff, dedicated rooms, and protocols and guidelines to improve the management of these conditions

Analysis of public health-care facilities in rural India

PurposeThis paper aims to analyze the status of infrastructure, workforce and basic amenities at public health-care facilities in rural India and draw a comparison with its urban counterparts.Design/methodology/approachRural Health Statistics data and National Sample Survey Office Report for the period 2019–10 were used to analyze lower-level public health facilities, namely, subcenters, primary health centers and community health centers (CHCs). Selected tracer indicators under World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) mechanism such as health center density, core health workforce density and basic amenities were used to carry out the analysis. The extent of facility coverage was measured using the National Rural Health Mission (NRHM) guidelines and the proportion of facilities satisfying the Indian Public Health Standards (IPHS) was measured to assess the service provision quality in rural public health-care facilities.FindingsResults indicated that the density of public health centers is higher in rural areas than in urban areas. Almost all public health-care facilities lack basic amenities in rural areas. Working positions for health specialists in CHCs barely meet the total requirement. Almost all of the public health facilities functioning in rural areas do not meet the IPHS norms.Originality/valueTo the best of the authors’ knowledge, the present paper is the first initiative to assess the status of rural public health-care facilities on the national level using WHO’s SARA indicators as well as NRHM and IPHS guidelines. The study is significant in terms of policy input for achieving universal health coverage in India.

Malaria diagnosis in rural healthcare facilities and treatment-seeking behavior in malaria endemic settings in western Kenya.

Accurate malaria diagnosis and timely treatment are requirements for effective management of the disease. However, treatment efficacy may be significantly reduced in resource-constrained healthcare facilities with poorly equipped laboratories and frequent drug and rapid diagnostic test kit (RDT) stock-outs. Furthermore, patient may avoid seeking treatment from such facilities. The study's goal was to determine treatment-seeking behavior, malaria diagnosis and treatment quality, and likely treatment-seeking determinants in the local population. Passive case detection, which targeted all patients with suspected malaria cases, was conducted in ten public healthcare facilities over a three-month period. Monthly malaria cases, methods of diagnosis and antimalarial drug availability were assessed. A household-based survey was also carried out. Structured questionnaires were used to collect knowledge, attitude and practice (KAP) data from household heads. Malaria knowledge, treatment seeking behavior, and predictors of malaria treatment-seeking were all determined. Three of the seven dispensaries lacked a laboratory to conduct microscopy- diagnosis. These three dispensaries also experienced frequent RDT stock-outs, which resulted in depending on clinical signs as diagnosis for malaria. The majority of local residents with fever (50.3%) purchased antimalarial drugs from a chemist. About 37% of fever patients sought treatment at healthcare facility while the remaining 12.7% did not treat their fevers. In irrigated areas, 45.5% (46/64) of fever patients sought treatment at healthcare facilities, compared to 25% (18/64) in non-irrigated areas (p = 0.009). Most children aged below 5 who had fever (77.7%) were taken to healthcare facility for treatment compared to 31.4% of children aged 5-14 years or 20.9% of adults (0.0001). Predictors of treatment seeking included access to healthcare facility (OR = 16.23, 95% CI: 2.74-96.12), and ability to pay hospital bills (OR = 10.6, 95% CI: 1.97-57). Other factors that influenced health-seeking behavior included the severity of symptoms, the age of the patient and knowledge of malaria symptoms.

Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia

Background: Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods: This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen’s TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results: In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion: The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women’s attitude, subjective norm, and spouse’s education associated with intention to undergo CBE.

Technologically Punctual? A Preliminary Evaluation of Differences between Face-to-Face and Video Check-In Times for Initial Mental Health Services.

Video-based telehealth provides mental health services to underserved populations. As decision makers reevaluate service offerings following COVID-19, it remains prudent to evaluate the utility of ongoing telehealth options among rural healthcare facilities, the primary healthcare source for many rural individuals. As research continues to compare video and face-to-face services, one understudied component is attendance. Although video-based telehealth has demonstrated improved show-rates for mental health services when compared to face-to-face methods, limited work has clarified whether video improves patient punctuality for these appointments, a documented challenge prevalent for patients with mental health-related concerns. A retrospective electronic record review of psychiatry, psychology, and social work initial patient visits between 2018-2022 was conducted (N = 14,088). Face-to-face visits demonstrated a mean check-in time of -10.78min (SD = 26.77), while video visits demonstrated a mean check-in time of -6.44 (SD = 23.87). Binary logistic regressions suggested that increased video usage was associated with a decreased likelihood of late check-in (B = -0.10, S. E. = 0.05, Exp(B) = 0.91, 95% CI = 0.83 - 1.00). Exploratory binary logistic regressions evaluated age, sex, race, ethnicity, specialty, insurance type, and diagnostic classification influence on video initial visits. Increased video usage was associated with a statistically decreased likelihood of late check-in; however, clinically, both face-to-face and video visits exhibited mean check-in times prior to the initial visit's scheduled time. As such, mental health organizations are encouraged to continue offering both face-to-face and video as options to foster evidence-based practices to the broadest population.

Acute flaccid paralysis surveillance and management in rural and urban reporting sites in Northern Nigeria

Abstract Background: The study evaluated the significance of acute flaccid paralysis (AFP) surveillance within the polio eradication strategy and its integral role in the overall eradication efforts. Specifically, the research assessed the implementation of AFP surveillance and its management at reporting sites in Northern Nigeria. Materials and Methods: This study utilized quantitative research methods, including administering interviewer-administered questionnaires to health facility staff and caregivers of children within the community. The research was conducted between May and July 2019 and involved 592 participating health facilities enrolled in the AFP surveillance program for polio eradication. These facilities were spread across 11 states in Nigeria’s Northeast and Northwest regions. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, Version 25.0 (Armonk, New York). Results: A total of 171 AFP cases were reported 6 months prior, with the highest proportion recorded in Kano (18.7%), Bauchi, and Kaduna (13.5% each) states. Most cases were seen in rural areas (73.1%), with an average of 1–3 cases (80.8%). Of the 171 AFP cases reported in the past 6 months, &gt;90% were investigated, &gt;80% had a complete clinical investigation, and &gt;70 were followed up for residual paralysis examination. Most rural health facilities (&gt;80%) had 1–3 trained staff compared with 70.9% of facilities in urban areas. On the other hand, the proportion of facilities in urban areas with 4–6 trained staff was almost double rural area facilities (18.4% vs. 9.8%). It was a surprise that a higher proportion of pastoral facility staff was able to define AFP correctly (94%) than urban facilities with 85.1% (P &lt; 0.05). Also, AFP surveillance and management were better in rural facilities than in urban. Conclusion: According to the research findings, the AFP surveillance system in the northern region demonstrated strong performance. However, urban and rural healthcare providers require regular training in AFP surveillance to maintain practical surveillance standards.

A comprehensive analysis of stroke admissions at a rural Nigerian tertiary health facility: Insights from a single-center study.

This research intended to examine the demographic and clinical attributes of stroke admissions in a rural Nigerian hospital. A retrospective analysis of stroke admissions was conducted over 1 year. All necessary data were obtained from patients' records and SPSS was employed for data analysis. P < 0.05 was deemed significant. There were 52 stroke cases, accounting for 5.9% of medical admissions. The patients' mean age was 62.81 ± 12.71 years, while females constituted 51.9% of cases. Common risk factors included hypertension (76.9%), hyperlipidemia (38.5%), alcohol (26.9%), and diabetes mellitus (26.9%). Clinical manifestations included hemiparesis/plegia (84.6%), altered consciousness (63.5%), slurred speech (61.5%), cranial nerve deficit (61.5%), aphasia (42.3%), and headache (34.6%). Ischemic stroke (71.2%) predominated over hemorrhagic stroke (28.8%). The average hospitalization duration was 17.62 ± 8.91 days, and the mean onset to arrival time was 121.31 ± 136.06 h. Discharge and mortality rates were 82.7% and 13.5%, respectively. The association between stroke subtypes and mortality was significant (P = 0.001). Stroke constitutes a significant portion of medical admissions in Nigeria, with ischemic stroke being more prevalent. High mortality rates underscore the urgent need to manage risk factors to prevent stroke.