Secondary Facilities Research Articles

Stakeholders’ Perspectives on Rehabilitation Services in KwaZulu-Natal Province, South Africa: A Mixed-method Study

Background and Objectives: South Africa is committed to enhancing rehabilitation services by 2030 through the National Rehabilitation Policy and the United Nations Convention on the rights of persons with disabilities. However, limited research focuses on rehabilitation services in KwaZulu-Natal (KZN) Province, South Africa. This study aims to provide insights from stakeholders on rehabilitation services in KZN Province focused on infrastructure, referrals, human resources, and multidisciplinary practices. Methods: Using mixed methods, we conducted focus group discussions, interviews, and surveys involving 99 stakeholders, including rehabilitation practitioners, district and provincial managers, and social development representatives from eThekwini, AmaJuba, and King Cetshwayo in South Africa. Descriptive statistics and thematic analysis were used for quantitative and qualitative data. Results: Public institutions reported inadequate referral pathways (2.9 out of 5) compared to private institutions (3.4 out of 5). Acute rehabilitation referrals primarily targeted secondary or tertiary facilities. Disjointed pathways, a lack of protocols, delayed referrals due to various factors and insufficient staff were identified. Physiotherapists were disproportionally more prominent, while social workers, psychologists and bio-kineticists were scarce. Both public (93%) and private (73%) care exhibited high doctor-to-patient ratios. Rehabilitation service disciplines were limited and fragmented, especially in rural areas. Thirty-four respondents (81%) stated no designated rehabilitation services units in their respective institutions. Conclusion: Rehabilitation services, though present at all care levels in KZN, mostly begin at tertiary levels. Local-level rehabilitation is non-existent, with the public healthcare system relying on community rehabilitation workers. Referral pathways require standardization, especially at the local level. Enhancing primary healthcare’s rehabilitation focus by bolstering workforce recruitment can significantly improve multidisciplinary practices. Expanding intermediate care facility licenses can alleviate system strain on KZN’s public health sector.

Handling client financial insolvency in maternity services: An occurrence, experience and policy gap qualitative analysis among healthcare stakeholders in North-Central Nigeria.

To assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services. A qualitative study was conducted in North-Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility-heads, program managers and policy makers at local and state government levels through In-depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package. Participants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker-related (staff scavenging for needed consumables, fund-raising among facility staff), facility-related (revolving fund, medical social welfare, welfare committee, discharge with re-payment plan, fee-waiver), community-related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post-discharge re-payment agreements. Participants suggested a client-friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale-up of health insurance for pregnant women to curb financial insolvency. Tackling client financial insolvency requires policy documents, support to private facilities, effective debt-recovery mechanisms, and scale up of health insurance for pregnant women.

Advancing human mobility modeling: a novel path flow approach to mining traffic congestion dynamics

Mining traffic congestion dynamics presents difficulties in data structure and spatiotemporal analysis. Existing studies mainly provide insights from a supply perspective, with a restricted examination of why congestion occurs and how travel demands affect congestion. This study introduces an innovative framework to mine congestion dynamics from the perspective of human mobility. In human mobility modeling, we refine the conventional origin-destination representation of activity flow by introducing "path flow" (PF) which considers space-time paths and movement patterns. In congestion scenarios, congestion-related path flow (CPF) and congested path sub-flow (CPSF) are extended to track individuals’ congestion exposure and explore the correlations between congestion and human mobility. To finely classify congestion-related travel demands, a Bayesian inference approach, incorporating destination and spatiotemporal heterogeneities, is developed to deduce trip purposes. The experiments conducted in Wuhan demonstrate the availability and importance of PF in spatiotemporal dynamics analysis of human mobility. Interestingly, we find that 1) the job-housing relationship is imbalanced, with massive residents opting for cross-district living and working; 2) individuals tend to visit tertiary hospitals on weekends and secondary medical facilities with less congestion on weekdays. Notably, path flow can promote the fine-grained modeling of human mobility and provide theoretical support for many urban issues.

Comprehensive School Physical Activity Programming in Dubai International Schools: A Mixed Methods Study

The purpose of this study was to examine comprehensive school physical activity program (CSPAP) policies and practices in interna-tional schools in Dubai, the United Arab Emirates. Following an ex-planatory-sequential mixed-methods research design, the researchers employed the Comprehensive School Physical Activity Program Policies and Practices Questionnaire (CSPAP-Q) and follow-up interviews to describe CSPAP implementation and explore implementation enablers and challenges. A convenience sample of physical education teachers (N=18) participated in the questionnaire, and seven of these teachers participated in individual interviews. Teachers’ responses to the ques-tionnaire indicated considerable heterogeneity and numerous gaps in existing school-based physical activity opportunities and promotion O'Reilly and Websterefforts. Interviews revealed three themes related to CSPAP implemen-tation: (a) time constraints in secondary schools, (b) facilities, and (c) location. This study provides an initial glimpse into whole-of-school physical activity programming in Dubai international schools.

An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management. The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors. Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care. Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.

Enhancing Nursing Competence in China: The Interplay of Resilience, Mindfulness and Social Support

ObjectivesTo address the nursing crisis, it is imperative to comprehend the factors that influence nursing competencies, which are crucial for the delivery of quality patient care. BackgroundFacing demographic shifts and increasingly complex healthcare demands, China's nursing sector struggles with workforce shortages and the need to enhance core competencies. This research explores the interplay of social support, psychological resilience, mindfulness and nursing competencies in various hospital environments in China. MethodsThrough a cross-sectional survey, 941 nurses across tertiary, secondary and private healthcare settings completed self-assessment questionnaires. The analysis included multiple linear regression and comparative methods to assess how psychological resilience, mindfulness and social support have an impact on nursing competencies. ResultsFindings revealed a strong relationship between psychological resilience and nursing competencies, with resilience being a key predictor. Mindfulness and social support also significantly contributed to competency levels. Nurses in tertiary hospitals showed greater competencies than those in secondary or private facilities. ConclusionEnhancing nursing competencies requires targeted interventions focusing on professional development and supportive workplace cultures. Incorporating psychological resilience, social support and mindfulness into nurse training is crucial for improving practice and policy.

Utilisation of Children's Emergency Services in a Semi-urban Nigerian Tertiary Health Facility

Background: Children's emergency services are still evolving in Nigeria. The description of the attributes of children attending Children Emergency Services in Nigeria is yet to be extensively studied in recent times. This can guide resource allocation and help develop health policies that advance children's emergency care. Objective: To review the profile of children patronising children’s emergency services in a tertiary health institution in a semi-urban setting in Nigeria. Methods: The study was a descriptive, cross-sectional survey among seventy-five caregiver-child pairs attending the children's emergency room of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Results: The mean age of the parents was 39.76±9.21 years and 33.47±8.11 years for the fathers and mothers, respectively. About two-thirds (65.4%) of the children were aged five years and below with male preponderance (69.3%). The highest educational level reported was secondary among 53.3% of the fathers and 42.7% of the mothers. Sixty-eight per cent (68%) of the children came on self-referral. Fever was the most common presenting complaint (72.0%) and paracetamol was the most commonly used medication as home remedy (21.3%). Conclusion: Most children utilising emergency services arrived at the facility on self-referral. There is a need for increased advocacy to ensure that the referral systems effectively function in referring patients to tertiary facilities from either primary health or secondary facilities.

Mesozooplankton production and respiration across a trophic gradient in a coastal Eastern Mediterranean ecosystem

The Inner Saronikos Gulf has served as an area of continuous environmental monitoring for many decades, primarily due to the operation of primary and secondary sewage treatment facilities of the Psyttalia Waste Water Treatment Plant (WWTP). In this groundbreaking study within the region, we conducted measurements of biochemical indices related to respiration (referred to as spETS) and growth (referred to as spAARS) of mesozooplankton. These measurements were then correlated with both biological and environmental data. The ecological quality of the inner Saronikos Gulf was ameliorated moving away from the sewage outfall and thus mesozooplankton sampling encompassed various sites located across a trophic gradient from the WWTP during different seasons (May, September, November 2017, and January 2018). Our observations revealed seasonal variations in both zooplankton abundance and composition, alongside spatial disparities in environmental data. In terms of biochemical data, we observed significant seasonal fluctuations in spETS and R respiration values. Notably, the lowest respiration R value (0.22 mg C m⁻³ d⁻1) was recorded in May, while the highest (4.74 mg C m⁻³ d⁻1) was observed in September. Nevertheless, the variations in spETS and spAARS values among different sites did not demonstrate statistically significant differences. Furthermore, the values of these indices (spETS and spAARS) exhibit a positive correlation with temperature and mesozooplankton biomass at a significance level of 0.01. Lastly, it is noteworthy that phytoplankton production, measured in terms of carbon content (mg C m⁻2), appeared to adequately meet the carbon requirements of the zooplankton throughout all the examined months.

Differential effect of China's Zero Markup Drug Policy on provider-induced demand in secondary and tertiary hospitals.

Following the marketization of China's health system in the 1980's, the government allowed public hospitals to markup the price of certain medications by 15% to compensate for reduced revenue from government subsidies. This incentivized clinicians to induce patient demand for drugs which resulted in higher patient out-of-pocket payments, higher overall medical expenditure, and poor health outcomes. In 2009, China introduced the Zero Markup Drug Policy (ZMDP) which eliminated the 15% markup. Using Shanghai as a case study, this paper analyzes emerging and existing evidence about the impact of ZMDP on hospital expenditure and revenue across secondary and tertiary public hospitals. We use data from 150 public hospitals across Shanghai to examine changes in hospital expenditure and revenue for various health services following the implementation of ZMDP. Our analysis suggests that, across both secondary and tertiary hospitals, the implementation of ZMDP reduced expenditure on drugs but increased expenditure on medical services, exams, and tests thereby increasing hospital revenue and keeping inpatient and outpatient costs unchanged. Moreover, our analysis suggests that tertiary facilities increased their revenue at a faster rate than secondary facilities, likely due to their ability to prescribe more advanced and, therefore, more costly procedures. While rigorous experimental designs are needed to confirm these findings, it appears that ZMDP has not reduced instances of medical expenditure provoked by provider-induced demand (PID) but rather shifted the effect of PID from one revenue source to another with differential effects in secondary vs. tertiary hospitals. Supplemental policies are likely needed to address PID and reduce patient costs.

Persepsi Pengunjung dalam Penilaian Infrastruktur Pariwisata Pesisir Pantai Indah Kapu: Fokus pada Ketersediaan Fasilitas Pengunjung

Tourism facilities are the completeness of tourist destinations that can meet the needs of tourists in enjoying their tour. Tourism facilities are completeness that must exist in tourist destinations that can serve tourists to enjoy tourist visits. Tourism facilities are also considered as physical elements designed and established to serve visitors. Tourism facilities are divided into three, namely basic, complementary, and supporting tourism facilities. Complementary facilities are facilities with the aim that tourists can be comfortable and stay longer. Forms of complementary facilities include sports facilities, secondary tourism facilities, and other entertainment. The availability of tourism facilities at Pantai Indah Kapu, Sani - Sani village, Samaturu sub-district, Kolaka district, is categorised as moderate. This shows that the value of the public perception of the availability of facilities. The level of visitor satisfaction with Pantai Indah Kapu tourist attraction, categorised as moderate, this affects the public perception of tourist satisfaction.

Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

ObjectiveTo estimate inpatient care costs of childhood severe pneumonia and its urban–rural cost variation, and to predict cost drivers.DesignThe study was nested within a cluster randomised trial of childhood severe...

IJCM_261A: Reaching the unreachable: An outreach based approach of IGMC Shimla to organise Ayushmann Health Melas/ Camps at Secondary level facilities in 03 districts of Shimla, Solan and Bilaspur in vicinity of the college

Background: Soul of India lives in its villages with >65% population living in rural settings. Saturation of all services especially Health services is at core of “leave no one behind” in line with principle of ‘Antyodaya’ reaching out at all. To build momentum with Pradhan Mantri Jan Arogya Yojana Ayushman Health Camps were organised by IGMC Shimla at secondary level facilities under flagship campaign Ayushman Bhavah Objective: Evaluation of health care services delivered by IGMC Shimla in Ayushmann Health Melas at secondary level facilities of 03 districts of Himachal Pradesh. Methodology: Ayushman Melas organised by IGMC Shimla at secondary level facilities from September 2023 to December 2023 in 03 districts Shimla (25); Solan (12) and Bilaspur (13) for providing clinical services to beneficiaries. Real time portal based reporting and analysis of same alongwith specialitywise footfallbifurcation is core. Results: As per Real time-based portal report analysis a footfall of 10379 registered out of which 9055 (87.24%) availed specialists services and 1324(12.74%) general physician services. A net of 2672 (29.5%) beneficiaries availed internal medicine specialist services, 458 (5.05%) surgical, 1619 (17.87%) orthopaedics, 772 (8.52%) obstetrics and gynaecology, 1460 (16.12%) Opthalmology, 698 (7.7%) Otorhinolaryngology, 152 (1.67%) psychiatry, 493 (5.44%) dermatology and 731 (8.07%) paediatric services respectively. 1012(9.75%) new diagnosed Hypertensives and 945 (9.10%) new diagnosed Diabetics, 1492 14.37%) beneficiaries screened for Oral Cancers, 804 (7.75%) for breast cancers and 468 (4.5%) for cervical Cancers. 299 (2.88%) new diagnosed cataract cases. 10379 beneficiaries were tested for 11102 tests (106.96%). Conclusion: Comprehensive health care service delivery by camps to unreachable for screening, diagnosis, one stop multi-speciality consultancy, referral and digitalisation of health vitals.

The Adolescent Patient Perspective on Activity Limitations Following Sport-Related Concussion.

Assessment of sport-related concussion (SRC) has begun to include patient- reported outcome measures (PROMs). However, there is a limited understanding of which health limitations are most meaningful to adolescents following SRC. To explore patient-perceived activity limitations following SRC and throughout recovery to return-to-play (RTP) and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age=14.9±3.5 years, grade=10.2±0.93 level) with a medically diagnosed SRC. The Patient Specific Functional Scale (PSFS) was used to assess changes in the patient's condition and the impact the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) following SRC and at RTP. Activities impacted by injury were coded into common categories and themes by a three-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into six themes: activities of daily living (ADLs), cognitive and school (COG), sports and physical activity (SPA), screen time (SCR), sleep (SLP) and social (SOC). On D3, all patients (50/50) identified at least one activity limitation. The majority related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation (AP) domain. Our primary findings suggest that sport-related concussion influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

A Unique Case of Appendiceal Intussusception (Inversion): A Case in Bloom.

A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation.

Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

Effect of integrated supportive supervision on availability of resources for health care service delivery and uptake of services in Ekiti State, Southwest Nigeria, evidence from the Saving One Million Lives program for result supported facilities.

a world bank performance-based financing program. The Saving One Million Lives program for results supported integrated supportive supervision (ISS) in selected primary health facilities (PHF) in Ekiti State, Nigeria. The study assessed the impact of ISS on health service outputs and outcomes such as infrastructure, basic equipment, human resources for health (HRH), essential drugs, number of children receiving immunization, number of mothers who gave birth in the facility, number of new and continuing users of modern family planning and the number of pregnant women screened for HIV (human immunodeficiency virus). a cross-sectional survey of 70 SOME-supported facilities was used for the study. Parametric and non-parametric method of analysis was employed to compare the mean values of study indicators gathered over the 4 rounds of ISS visits from January 2018 to August 2020. the study demonstrated that ISS approach has a positive effect on PHC service outputs and outcomes such as infrastructure, basic equipment, health human resources (HRH), essential drugs, contraceptives prevalence rate, skilled birth attendant as well as postnatal care. However, there was no significant impact on HIV screening for pregnant women. integrated supportive supervision approach has a positive effect on the quality of health care delivery in PHCs in Ekiti State, Nigeria. It is therefore recommended that periodic ISS visits should be routinely carried out in all PHCs across the State in the country and can be further extended to secondary and tertiary facilities.

Strategies for developing layered oxide cathodes, carbon-based anodes, and electrolytes for potassium ion batteries.

Lithium-ion batteries (LIBs) have become the most popular portable secondary energy storage facilities. However, the limited lithium resource results in possible unsustainable development. Potassium-ion batteries (PIBs) are considered promising alternatives to LIBs because of their high resource availability, low cost, and environmentally friendly features. In this field, high energy density layered cathodes and carbon-based anodes are also the main research objectives. However, compared to the most appealing alternative sodium-ion batteries (SIBs), despite having various theoretical advantages, PIBs exhibit poorer electrochemical performance in practice. Their poor capacity retention and narrow working voltage range seriously limit their applications. The performance of the electrodes is usually considered an important factor for battery performance, life, and safety. To solve these problems, many significant research studies have been carried out in the last decade, achieving numerous breakthroughs. Nevertheless, there are still many drawbacks and unclear mechanisms. In this comprehensive review, we examine the current state of high-performance layered oxide cathodes, electrolytes, and carbon-based anodes, to identify potential candidates for PIBs. Our focus lies on their structural characteristics, interface properties, underlying mechanisms, and modification techniques. The viewpoints of these advanced strategies are integrated, and concise development suggestions and strategies are subsequently proposed.

Direct patient costs for drugs and consumables at fifteen health facilities in Southern Madagascar, a secondary analysis of patient invoices.

Financial risk protection in health is a key objective of the Sustainable Development Goals. However, financial risk protection mechanisms are limited, especially in low-income countries, such as Madagascar. To design effective financial risk protection mechanisms, solid and reliable data on the costs patients incur when seeking care are essential. With this study, we therefore aim to describe medical costs for drugs and consumables for patients as well as model the likelihood of catastrophic health expenditure at fifteen health facilities in Southern Madagascar. We conducted a costing analysis of patient invoices from fifteen health facilities (four primary and eleven secondary facilities) in Southern Madagascar, including public, private, and faith-based facilities. We included invoices from patients accessing care for life-threatening conditions, accidents and injuries, paediatric, or maternity care between February 2021 and July 2022. Costing data were limited to costs for drugs and consumables. We used regional household expenditure data from a representative household survey to calculate the incidence of catastrophic health expenditure in our sample. We analysed data from 9,855 cases, including 4,980 outpatient cases, 3,447 inpatient cases without surgical intervention, and 1,419 surgical cases. The average patient cost for drugs and medical consumables across all cases was USD 39.52 (range: USD 0.13-1,381.18, IQR: USD 9.07-46.91). Average costs for surgical treatment were USD 119.33 (range: USD 8.10-522.88, IQR: USD 73.81-160.49), for inpatient treatment USD 47.07 (range: USD 1.82-1,381.19, IQR: USD 22.38-58.91), and for outpatient treatment USD 11.73 (range: USD 0.15-207.79, IQR USD: 6.00-15.53). On average patients at faith-based facilities paid USD 47.20 (range: USD 0.49-530.33, IQR: 10.74-58.54), USD19.47 (range: USD 0.40-1,381.23, IQR: 6.77-24.07) at private facilities, and USD 34.65 (range: USD 0.58-245.24, IQR: USD 6.08-60.11) at public facilities. Patients requiring surgical care were most likely to experience catastrophic health expenditure and average costs for maternity care were significantly higher than for other patient groups. Financial risk protection schemes in Madagascar, such as the national UHC policy, and the national solidarity fund, as well as interventions by non-governmental and multilateral organisations, need to focus on surgical cases and maternity care to protect vulnerable populations from catastrophic health expenditures for life-threatening conditions, accidents and injuries, and maternity and paediatric care.

Perception and utilization of partograph among midwives across selected health care facilities in Abuja metropolis, Abuja: A comparative study

Currently, countries are uniting behind a new target to accelerate the decline of maternal mortality rate (MMR) by 2030. SDG 3 encompasses this target of reducing the global MMR to less than 70 per 100 000 births, with no country having MMR more than twice global average. One of the key requirements for averting MMR is provision of care by skilled birth attendant especially midwives, using and having positive perspective to such a tool as partograph, before, during and after childbirth. Hence, the present study. Stratified sampling was used in selecting facilities. Respondents who met the inclusion criteria were drawn proportionately using simple random sampling. Data was collected using a semi-structured questionnaire. Data entry was done using statistical package for social sciences (SPSS V. 21) while hypotheses testing was done using chi-square and ANOVA at statistically significant level of 0.05. Study variables were scored. Score &gt;3.0 was classified positive perception and &lt;3.0 otherwise while score ≥70% was considered adequate utilization and &lt;70% was considered otherwise. Findings showed age of respondents ranged from 39 - 59 years (38 ± 9.8). Two in every five of the respondents had 1 - 5 years of nursing job experience. Respondents had positive perception about partograph (mean 3.7(0.3)) yet inadequate (mean score 55.6%) utilization of the tool. Perception of partograph was significantly positive among respondents from primary facility (ANOVA = 12.38, p = &lt; 0.001) compared to respondents from secondary and tertiary facilities which translated to adequate utilization (χ2 = 68.08, df = 2, p = &lt;0.001) of partograph at that level of health care delivery. The study showed that perception and utilization of partograph in the primary health facility was more than in the secondary and tertiary facilities.

Effectiveness of smartphone otoscope in management of ear ailments at primary healthcare level

Background: To work out efficacy of smartphone otoscope for managing ear ailments at primary healthcare level. Methods: Prospective study carried out at a co-located primary care clinic and secondary referral facility. With this plan, the PHC was equipped with a smartphone otoscope for diagnosing common ear problems. The doctor then forwarded patient's ear imaging to the referring hospital's otolaryngologist. The otolaryngologist reviewed the history to make remote diagnosis before providing the PHC provider with recommendations for treatment. Information on patients' demographics, outpatient diagnoses, symptom durations, affected side, treatments received, and outcomes was collected. This information was used to determine whether or not a smartphone otoscope may be used to improve healthcare for patients suffering from common ear illnesses without sending them to more specialized facilities. Results: 150 patients were enrolled; 53.3% were male and 46.7% female. Participants aged between 3 and 83 years, with a mean of 44.6. Eighty-two (48%) of the cases presented with left ear, sixty (40%) with right ear, and eighteen (12%) for both sides. The typical course of ear infection lasted 6.5 (2, 15) days. Out of 150 patients, 33 (22%) were deemed cured, 117 (78%) demonstrated improvement in symptoms. The technique was praised by primary care physicians, who said they learned more about otolaryngology. Conclusions: The ability of primary care physicians to manage common and straightforward ear ailments is greatly enhanced by the use of smartphone otoscopes. Thus, improving patient satisfaction and the strain on medical facilities.