Secondary Health Facilities Research Articles

PRESENTATION AND MANAGEMENT OF DENTAL FLUOROSIS IN A RESOURCE LIMITED FACILITY.

Background: Dental fluorosis is a developmental disturbance characterized by excess fluoride in hard tissues of the teeth. The appearance of teeth affected by dental fluorosis may negatively affect individual self-esteem and overall quality of life. Thus, the need for treatment, though there is still debate on the best treatment modalities. The objective of this study was to document the presentation and management of dental fluorosis in a resource limited facility in north central Nigeria.
 Methods: A cross-sectional hospital-based study conducted among out-patients attending a secondary oral health care facility in Jos, north central Nigeria between June 2020 and June 2022. Sociodemographic characteristics were recorded. All patients were examined for presence of dental fluorosis. Dean’s Index was used to classify dental fluorosis. Patients with dental fluorosis who consented to the study were treated. Treatment modalities included oral prophylactic treatment, microabraision and resin infiltration. Data analysis was by the use of Statistical Package for Social Sciences (SPSS) version 23.0 A p-value of < 0.5 was taken as statistically significant.
 Results: During the study period, 1201 patients presented with different oral health challenges. Among these 200 (16.7%) were diagnosed of dental fluorosis. The mean of the patients with dental fluorosis was 14.15 ± 1.91 years. Nearly half 98(49.0%) of the patients who presented with dental fluorosis were children, 65(32.5%) were teenagers and 37(18.5%) were young adults (p=0.037). Among the patients, 123 (61.5%) were females. The moderate type of dental fluorosis 75(37.5%) was the commonest type of dental fluorosis seen. Out of the 200 patients with dental fluorosis, dental caries was present among 55(37.5%) patients. 185(92.5%) requested for treatment. 231 intervention procedures were undertaken on different classes of dental fluorosis.
 Conclusion: Dental fluorosis is prevalent among the dental out-patients seen at the study center during the study period. More patients presented with moderate class of dental fluorosis. Presentation was more among children and teenagers below 20 years. More female presented and requested for intervention than the males. Resin infiltration was found to be cost effective at this facility.

HL7-FHIR-Based ContSys Formal Ontology for Enabling Continuity of Care Data Interoperability.

The rapid advancement of digital technologies and recent global pandemic-like scenarios have pressed our society to reform and adapt health and social care toward personalizing the home care setting. This transformation assists in avoiding treatment in crowded secondary health care facilities and improves the experience and impact on both healthcare professionals and service users alike. The interoperability challenge through standards-based roadmaps is the lynchpin toward enabling the efficient interconnection between health and social care services. Hence, facilitating safe and trustworthy data workflow from one healthcare system to another is a crucial aspect of the communication process. In this paper, we showcase a methodology as to how we can extract, transform and load data in a semi-automated process using a common semantic standardized data model (CSSDM) to generate a personalized healthcare knowledge graph (KG). CSSDM is based on a formal ontology of ISO 13940:2015 ContSys for conceptual grounding and FHIR-based specification to accommodate structural attributes to generate KG. The goal of CSSDM is to offer an alternative pathway to discuss interoperability by supporting a unique collaboration between a company creating a health information system and a cloud-enabled health service. The resulting pathway of communication provides access to multiple stakeholders for sharing high-quality data and information.

Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies.

The Adolescent Health Quality of Care (AHQOC) index is a tool designed to evaluate the quality of facility-based adolescent sexual and reproductive health (ASRH) services. This descriptive cross-sectional study aimed to validate the AHQOC index in 27 primary and secondary public health facilities located in a rural and an urban local government area (LGA) of Ogun State, Nigeria. To conduct the study, 12 mystery clients (MCs) were recruited and performed 144 visits to the health facilities. The MCs were young males and females who were seeking information on premarital sex, pregnancy prevention, sexually transmitted infections (STIs), and contraception. The validity, and reliability of the AHQOC index were evaluated using exploratory factor analysis, Cronbach's Alpha, and intra-class correlation coefficient tests. The Kaiser-Meyer-Olkin test result for the initial 37-item pool was 0.7169, and the final tool retained 27 items with a Cronbach's Alpha of 0.80. Two subscales of the index had Cronbach's Alpha of 0.76 and 0.85. The intra-rater consistency assessed by the intra-class correlation coefficient was 0.66 (0.10-0.92) p = 0.001 for the urban LGA and 0.72 (0.37-0.91) p = 0.001 for the rural LGA. Positive and statistically significant relationships were observed between the full scales and subscales and the validity item (MC ranking of health worker on proficiency from 1 to 10). The results of this study demonstrate that the validated AHQOC index is a valuable tool for assessing the quality of ASRH services in public health facilities.

Incidence of blood culture-related sepsis in neonates and antibiotics sensitivity of implicated organisms in a secondary healthcare facility in Ghana.

We determined the incidence of blood culture-related sepsis, causative bacteria, and antibiotics sensitivity among newborn babies with suggestive signs of sepsis admitted at the Upper East Regional Hospital in Bolgatanga, Ghana. Prospective cross-sectional study. Newborn Care Unit of the Upper East Regional Hospital, Bolgatanga. Neonates admitted to the Newborn Care Unit from August 2019 to August 2020 with signs of sepsis. Organisms isolated from blood cultures and sensitivity of isolated organisms to antibiotics. The study included two hundred and seventy-six (276) patients. Laboratory confirmed sepsis was 13.4% (37/276). Early onset sepsis was 3.3% (9/276), while late-onset sepsis was 10.1% (28/276). The most common clinical signs associated with positive culture cases were temperature instability (35.5%), poor feeding (14.5%), neonatal jaundice (11.3%), vomiting (9.7%), and respiratory distress (8.1%). Staphylococcus aureus and Staphylococcus epidermidis were the most common bacterial isolates (46% and 32%, respectively). There was no relationship between independent variables and blood culture confirmed sepsis. Antibiotics to which isolates were most resistant included flucloxacillin 4/4, penicillin 14/15, ampicillin 16/18, and tetracycline 23/28. Bacterial isolates were most sensitive to amikacin 16/16, levofloxacin 5/5, erythromycin 8/8, cefazolin 7/8, and ciprofloxacin 18/24. Late-onset sepsis is a common sepsis category, and the implicated microorganisms are resistant to commonly prescribed antibiotics. This work was funded by Upper East Regional Hospital, Bolgatanga.

Challenges of Utilization of Emergency Obstetric care as Experienced by Midwives in Selected Secondary Health Facilities in Oyo State, Nigeria: A Qualitative Approach

Challenges of Utilization of Emergency Obstetric care as Experienced by Midwives in Selected Secondary Health Facilities in Oyo State, Nigeria: A Qualitative Approach

Assessing patient safety culture among healthcare professionals in Ibadan South-west region of Oyo State, Nigeria

Objectives Patient safety culture is essential to improve care, prevent adverse events, and deliver quality healthcare service. The levels of patient safety culture and adverse events in Nigerian healthcare institutions are still widely underreported. The main objective of this study was to assess patient safety culture among healthcare professionals in primary and secondary healthcare facilities in Ibadan South-west local government area of Oyo State, Nigeria. Methods In this cross-sectional study, investigators collected data with the English version of the Hospital Survey on Patient Safety Culture version 2.0 questionnaire. They analyzed data using the Statistical Package for the Social Sciences (SPSS) software with descriptive statistics, Pearson Correlation Analysis, and one-way analysis of variance. Results A total of 271 healthcare professionals participated in the study. Study findings showed the overall perception of patient safety culture to be 72.1%. Among patient safety dimensions, Teamwork (88.5%) and Reporting Patient Safety Events (47.4%) were the highest and lowest percentage of positive responses, respectively. Conclusions Patient safety culture is an emerging concept in Nigeria. The assessed dimensions showed the need to improve the safety culture among healthcare professionals. Therefore, stakeholders, policymakers, and managers should employ policies, strategies, and programs to enhance safety culture across all healthcare institutions.

Exploring communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia

BackgroundThe World Health Organization has promoted a shift towards the test-and-treat-all strategy to accelerate the elimination of HIV/AIDS. Zambia was one of the early African countries to adopt this strategy as the policy change was officially announced on national television by the republican president on 15th August 2017. This study explored the communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia.MethodsA qualitative case study design was employed with a purposeful sample of policy makers, international partners, National AIDS Council representatives, health facility managers, and frontline health providers in selected tertiary, secondary and primary health facilities in the Lusaka District, Zambia. Thematic data analysis was performed using NVivo 12 Pro software.ResultsIn total, 22 key informant interviews and 3 focus group discussions were conducted. The government relied on formal and informal channels to communicate the test-and-treat-all policy change to health providers. Whilst HIV policy changes were reflected in the National HIV/AIDS Strategic Framework, there was little awareness of this policy by the frontline providers. The use of informal communication channels such as verbal and text instructions affected health providers’ implementation of the test-and-treat-all. Electronic and print media were ineffective in communicating the test-and-treat-all policy change to some sections of the public. Top-down stakeholder engagement, limited health worker training, and poor financing negatively affected the implementation of the test-and-treat-all policy change. Acceptability of the test-and-treat-all policy change was shaped by positive provider perceptions of its benefits, limited sense of policy ownership, and resistance by the non-treatment-ready patients. Furthermore, unintended consequences of the test-and-treat-all policy change on human resources for health and facility infrastructure were reported. ConclusionEffective test-and-treat-all policy change communication is vital for successful policy implementation as it enhances interpretation and adoption among health providers and patients. There is a need to enhance collaboration among policy makers, implementers and the public to develop and apply communication strategies that facilitate the adoption of the test-and-treat-all policy changes to sustain gains in the fight against HIV/AIDS.

Factors associated with viral load non-suppression in people living with HIV on ART in Nigeria: cross-sectional analysis from 2017 to 2021

ObjectivesIdentify factors (demographic and clinical) associated with a non-suppressed viral load (VL) of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria.DesignCross-sectional study.SettingSixteen US Agency for International Development...

Serological prevalence of Herpes Simplex Virus, Syphilis, and H. pylori co-infections amongst HIV-infected individuals receiving care in a secondary healthcare facility in Port Harcourt, Nigeria

Helicobacter pylori is a widespread pathogen that significantly contributes to dyspeptic disease and gastric cancer. There are conflicting prevalence patterns of H. pylori in HIV-1-infected patients. Although the interaction between HIV and H. pylori infection is not well investigated, previous studies have suggested a decreased prevalence of H. pylori and the limited effectiveness of eradication treatment in HIV-positive individuals. Therefore, this study aimed to describe the serological prevalence of HIV/HSV, HIV/Syphilis, and HIV/H. pylori co-infection among HIV-infected individuals receiving care in a secondary healthcare facility in Port Harcourt, Nigeria. In the study, 100 HIV-infected individuals were screened for HSV, syphilis and H. pylori co-infections. Co-infections were 0.0% for HIV/HSV, 0.0% for HIV/Syphilis and 58.0% for HIV/Helicobacter pylori. Higher prevalence of HIV/H. pylori co-infection occurred among the age group <20-40 (59.5%), males (59.5%), unemployed (100.0%), Ahaoda, Eleme and Etche LGAs, and high CD4 counts of 200-349 and >350 cells/µl (58.3%) compared to other categories. This study confirmed the absence of HSV and syphilis among these participants. It further indicated that co-infection of HIV/H. pylori were high (58.0%), although the underlying mechanisms remained unknown. However, the H. pylori co-infection in HIV-infected individuals was associated (P>0.05) with CD4+ cell counts and any socio-demographic variables evaluated. However, more studies are needed on these patients in Rivers State, Nigeria, to evaluate the infection rate further.

Leaving no disease behind: The roadmap to securing universal health security and what this means for the surveillance of infectious diseases in Ghana as a precedent for sub-Saharan Africa.

Ghana is the first country in sub-Saharan Africa (SSA) to aim for universal health coverage (UHC). Based on Ghana's UHC system, the accessibility and distribution of healthcare facilities were evaluated for 2020. Projecting into 2030, this study aimed at providing geographical information data for guiding future policies on siting required healthcare facilities. Ghana as a precedent for SSA was evaluated and proposed to "leave no disease behind" in the surveillance of infectious diseases (IDs). This is to reinforce the sustainable development goals (SDG) 3 agenda on health that underpins monitoring equity in "leaving no one behind." Geospatial accessibility, travel time data, and algorithms were employed to evaluate the universality and accessibility of healthcare facilities, and their future projections to meet UHC by 2030. Healthcare facilities as surveillance sites were compared to community-based surveillance to identify which would be more applicable as a surveillance system to leave no disease behind in Ghana. Ghana has 93.8%, 6.1% and 0.1% as primary, secondary and tertiary healthcare facilities respectively. It has 26.1% of healthcare facilities remaining to meet the SDG 3 health target by 2030. In terms of providing quality healthcare, 29.3% and 67.2% of the additional required healthcare facilities for optimal allocation and achieving the UHC target need to be secondary and tertiary respectively. In assessing the broad spectrum of IDs studied from 2000 to 2020, an average of 226 IDs were endemic or potentially endemic to Ghana. The majority of the studies carried out to identify these IDs were done through community-based surveillance. Establishing community-based surveillance sites to leave no disease behind and also providing the required healthcare facilities to reinforce leaving no one behind will enhance the universal health security of Ghana as a precedent for SSA.

Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study

Despite government efforts, many rural Pakistani women forgo regular antenatal visits, are unprepared for birth, and deliver at home or in private facilities, because they are dissatisfied with public health services. This study examined pregnant women's perceptions of public health hospital prenatal care to suggest areas for improvement. Using simple random sampling, 200 pregnant women visiting a secondary care public health facility in Sargodha District, Pakistan, were enrolled in a cross-sectional study. The quality of prenatal care was assessed using a structured and validated questionnaire. Descriptive analysis and multivariate linear regression stepwise models were used. Of participants, 52% consider the services to be of poor quality. Education, income, number of living children, and long waiting time influenced the perceived prenatal care quality in the study population. Stakeholders rated existing services as suboptimal, especially in terms of staff availability and time spent, which reduces service use. Facility managers and policymakers should work to improve the quality of services to satisfy patients, encourage them to use antenatal care, and improve the health of both mother and child, especially in rural areas.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique

BackgroundThe unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province.MethodsA mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated.ResultsNampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope.ConclusionsThere is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.

Bed space, referral capacity and emergency response of the healthcare facilities in lagos state: a key to improving healthcare

Background: A health system comprises various elements such as infrastructure, human resources, data systems, and financial systems. Adequate infrastructure, including buildings, equipment, supplies, and communication, is crucial to health services. In Nigeria, some healthcare facilities do not have the needed human and infrastructure resources to manage specific conditions, causing multiple referrals and endangering patients' lives. The present study assessed the availability of in-patient beds and the referral capacity and emergency response of the healthcare facilities in Lagos State. Methods: This study leveraged Noi Polls census data on Health Facility Assessment for Lagos state conducted between November 2020 and December 2021. The survey was conducted in 1256 health facilities which are 53.8% of the entire health facilities in Lagos State, and 53.8% of the population of Lagos State was used to compute the bed/population ratio. A descriptive analysis was done to present the findings. Result: Findings revealed that Lagos State has eight (8) beds per 10,000 population which is below the global average of twenty-six (26) beds per 10,000 population and the recommended five (5) beds per 1,000 population by the World Health Organisation. The results further reveal that healthcare facilities in Lagos State need additional 2,861 beds to reach the Sub-Saharan average in-patient beds of twelve (12) per 10,000 population and an additional 31,953 beds to reach the recommended five (5) per 1,000 populations by the World Health Organization. Conclusion: Infrastructures such as beds, emergency rooms, and the emergency transportation services needed to transport patients to other facilities are lacking in most of the healthcare facilities in Lagos State. Secondary healthcare facilities in the State cannot discharge their roles, especially handling referred patients, as they lack bed space to care for in-patients and emergency rooms to carter for emergency cases.

Availability of Infection Control Protocol and Facilities, Practice Level and Barrier Perception Among Healthcare Workers in Secondary Healthcare Facilities, Southern Cross River State, Nigeria

The practice of infection prevention and control is key to prevention of healthcare acquired infections and protection of healthcare workers, patients and public health. There are however several challenges militating against the use of standard precautions among healthcare workers. This study was aimed at assessing availability of infection prevention and control (IPC) protocol and facilities, practice level and barrier perception among healthcare workers in secondary healthcare facilities, Southern Cross River State, Nigeria. The study adopted a cross-sectional descriptive design using quantitative methods to elicit information from 336 healthcare workers. A structured questionnaire was administered to respondents in this study an observational checklist was also used. The data generated was analyzed using SPSS version 25. The study comprised of 87.5% females and 12.5% males. Existence of IPC protocols in the facilities was assessed and over half of the respondents (53%) agreed to the availability of IPC protocols in their healthcare facilities. The study identified lack of: knowledge, time, equipment/materials and resources as factors perceived by healthcare workers as influencing their practice of IPC. Among all the factors, only lack of equipment/materials was found to be a significant perceived barrier to practice of IPC (t= 0.269, 0.012). The level of IPC practice was however found to be higher among those who perceived these factors as barriers. It is concluded that lack of time, knowledge, materials/equipment and resources are probable factors influencing practice of infection prevention and control in the secondary healthcare facilities. Healthcare facility management should make adequate provision of requirements for infection control in addition to training of staff and regular monitoring of compliance among health workers to protect public health.

Choices and availability of family planning services: evidence from census-based health facility assessment data in Bauchi state, Nigeria

Background: Controlling family planning (FP) has long been the goal of most nations and cultures. FP aims to keep the population under control while also improving living conditions. Many countries, especially the developing ones, which Nigeria is among, face the challenge of dealing with overpopulation due to high fertility rates. FP is considered a veritable way of dealing with high fertility problems. The present study assesses the choices and availability of FP services in Bauchi state health facilities. Methods: This study leveraged Noi Polls census data on Health Facility Assessment for Bauchi state. We conducted a descriptive analysis and analyzed the primary health facility assessment data using counts and percentages. Result: Findings of the study revealed that 80% of the health facilities studied in Bauchi State offer FP services. 91.2% and 77% of the facilities in the urban and rural areas, respectively, offer FP services. This translates to 8.8% and 23% of health facilities in urban and rural areas, respectively, not offering FP services. Based on proportions, assessing the facilities that offer FP by ownership shows that public health facilities are more into FP services (80%) compared to the private-for-profit (80%) health facilities and facilities owned by NGOs and faith-based organizations (83.3%). By facility level of care, 87.5% of secondary healthcare facilities in Bauchi State offer FP services compared to primary healthcare facilities (79.5%). FP services provided in the studied facilities include counseling, contraceptive injectables, oral contraceptive pills, male and female condoms, implants, Intra-Uterine Contraceptive Devices IUCD, sterilization methods, and natural/traditional methods. Conclusion: Considering that over 80% of health facilities considered in this study locates in rural Bauchi state, with over 22% not offering FP clearly shows a gap that the government must address. The distribution of FP services across the state's local government areas is inequitable as some local governments have more health facilities offering the services than others, thus giving residents in those areas a higher chance of benefitting from those services.

Antibiotic consumption trends in Ghana: analysis of six-years pharmacy issue data from a secondary healthcare facility.

Surveillance of hospital antibiotic consumption provides data to inform corrective action and for monitoring antimicrobial stewardship activities. This study described antibiotic consumption patterns from 2016 through 2021 at a secondary healthcare facility in Ghana. Using the WHO methodology for surveillance of antimicrobial consumption in hospitals, we analysed a 6-year pharmacy issue data at the Eastern Regional Hospital. We report on the defined daily dose (DDD) per 100 patients, types of antibiotics consumed according to Anatomic Therapeutic Classification (ATC), WHO AWaRe classification; trends in antibiotic consumption and expenditure per DDD of antibiotics consumed. Over the period, the mean (±standard deviation) antibiotic consumption rate was 256.7 ± 33 DDD/100 patients per year. A linear regression model showed an insignificant decreasing trend in antibiotic consumption (coefficient for time -0.561; P = 0.247). The top three consumed antibiotics in DDD/100 patients at ATC level 5 were amoxicillin-clavulanate (n = 372.6), cefuroxime (n = 287.4) and sulfamethoxazole-trimethoprim (n = 145.8). The yearly Access-to-Watch ratio decreased from 2.4 in 2016 to 1.2 in 2021. The mean yearly cost of antibiotics was $394 206 ± 57 618 US dollars. The top three antibiotics consumed in terms of cost were clindamycin $718 366.3, amoxicillin-clavulanate $650 928.3 and ceftriaxone $283 648.5. This study showed a sturdy rate of antibiotic consumption over the 6-year period with a year-on-year decrease in the Access-to-Watch antibiotic ratio. Data from pharmacy drug issues offer an opportunity to conduct antibiotic consumption surveillance at the hospital and national level in Ghana.

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

“They talked to me rudely”. Women perspectives on quality of post-abortion care in public health facilities in Kenya

BackgroundAccess to safe abortion is legally restricted in Kenya. Therefore, majority women seeking abortion services in such restrictive contexts resort to unsafe methods and procedures that result in complications that often require treatment in health facilities. Most women with abortion-related complications end up in public health facilities. Nevertheless, evidence is limited on the quality of care provided to patients with abortion complications in public health facilities in Kenya.MethodsData for this paper are drawn from a qualitative study that included interviews with 66 women who received post-abortion care in a sample of primary, secondary and tertiary public health facilities in Kenya between November 2018 and February 2019. The interviews focused on mechanisms of decision-making while seeking post-abortion care services, care pathways within facilities, and perceptions of patients on quality of care received including respect, privacy, confidentiality, communication and stigma.FindingsThe participants’ perceptions of the quality of care were characterized as either “bad care” or “good care”, with the good care focusing on interpersonal aspects such as friendliness, respect, empathy, short waiting time before receiving services, as well as the physical or functional aspects of care such as resolution of morbidity and absence of death. Majority of participants initially reported that they received “good care” because they left the facility with their medical problem resolved. However, when probed, about half of them reported delays in receiving care despite their condition being an emergency (i.e., severe bleeding and pain). Participants also reported instances of abuse (verbal and sexual) or absence of privacy during care and inadequate involvement in decisions around the nature and type of care they received. Our findings also suggest that healthcare providers treated patients differently based on their attributes (spontaneous versus induced abortion, single versus married, young versus older). For instance, women who experienced miscarriages reported supportive care whereas women suspected to have induced their abortions felt stigmatized.ConclusionThese findings have far reaching implications on efforts to improve uptake of post-abortion care, care seeking behaviors and on how to assess quality of abortion care. There should be emphasis on interventions meant to enhance processes and structural indicators of post-abortion care services meant to improve patients’ experiences throughout the care process. Moreover, more efforts are needed to advance the tools and approaches for assessing women experiences during post-abortion care beyond just the overriding clinical outcomes of care.

Значення мультидисциплінарного, міжвідомчого і міжсекторального підходів як умов впровадження системи паліативної та хоспісної допомоги в Україні

Purpose - to carry out medical and social analysis of conditions and organizational aspects of the Palliative and Hospice Care (PHC) System implementation and development in Ukraine. Materials and methods. There were analyzed: domestic and foreign scientific literary sources; data of official statistics of the State Statistics Service and the Ministry of Health of Ukraine; normative-legal documents of Ukraine and authoritative international professional organizations. Аnd the following research methods were applied: bibliosemantic, system approach and system analysis, comparative content analysis and generally accepted medical-statistical methods. Results. The peculiarities of the medical and demographic situation in Ukraine in recent decades are the rapid population aging, high morbidity and mortality from cancer and severe complications of chronic noncommunicable diseases, significant spread of HIV/AIDS, tuberculosis, viral hepatitis B and C etc. This requires the creation and improvement of an adequate regulatory framework (RF), which regulates the development of an accessible multidisciplinary, interagency and intersectoral PHC System, which requires the development of outpatient PHC services and inpatient PHC facilities, coordination of institutions and agencies subordinate to various ministries and agencies, first of all, the Ministry of Health of Ukraine and the Ministry of Social Policy of Ukraine; introduction of a system of motivation and training of PHC providers and involvement primary health care facilities medical staff in the palliative care provision at home. Thus, affordable and high-quality PHC should be integrated into the Health Care and Social Protection System, as PHC in the early stages of a life-threatening or incurable disease can significantly reduce suffering and improve the quality of life for both palliative patients (PPs) and their families. Conclusions. The urgency of the problem of creating and developing a System of affordable, high quality and effective PHC in Ukraine is due to the unfavorable medical and demographic situation - population aging, increasing morbidity and mortality from cancer and chronic diseases, often accompanied by chronic pain syndrom and other severe symptoms that significantly reduce the quality of life of PPs. The implementation of the PHC System for the population requires political support from the Government of Ukraine, Regional and Local Authorities, appropriate financial support and the whole society participation. Implementation and development of the PHC System in Ukraine with adequate funding from the State Budget (National Health Service of Ukraine), as well as through state, regional and local targeted PHC Programs will provide quality and effective multidisciplinary and interagency palliative care on equal terms, regardless of the nosology of the disease, PPs place of residence/stay and social status. The results of the study allowed to adapt international experience and identify different forms of PНC, which, depending on the severity of the disease and at the request of PPs and their families, can be provided in specialized inpatient PНC facilities, PНC departments of secondary and tertiary health care facilities or outpatient settings, including at home, as well as in PHC facilities of any form of ownership and departmental affiliation, subject to compliance with the standards and requirements of the RF. No conflict of interests was declared by the authors.

Drug utilization, medication adherence and treatment satisfaction amongst glaucoma patients receiving care at secondary health facilities

Abstract Objectives The objective of this study was to assess treatment satisfaction, medication adherence and drug utilization amongst glaucoma patients receiving care at secondary health facilities. Methods A cross-sectional study was conducted amongst glaucoma patients attending eye clinics of General Hospital Ilorin and Civil Service Hospital Ilorin in Kwara State, Nigeria from October 2020 to January 2021. Three hundred and eleven patients were enrolled in the study. Sampling was based on convenience as dictated by the inclusion and exclusion criteria. Ethical permission and informed consent were obtained before data collection. Validated instruments of Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication were used during the data collection process. Descriptive and Chi-square analyses were employed. Key findings Amongst the 311 patients studied 184(59.2%) were females with a mean age of 63.79 ± 14.89 years. Timolol eye drop was the drug of choice for monotherapy in (8.7%) of patients. Combination therapy of beta blockers and carbonic anhydrase inhibitors had the highest number (59.5%) of prescriptions. More than half (55.6%) of the patients were adherents. Participants reported being more satisfied with their anti-glaucoma therapy in the domain of global satisfaction (62.89 ± 21.85) followed by medication effectiveness (62.67 ± 20.78) and convenience (60.16 ± 15.79) while medication side effects had the least score (17.17 ± 11.09). There is a statistically significant relationship between patient satisfaction with treatment and medication adherence at P= 0.001. Conclusions Combination therapy was the most frequently utilized anti-glaucoma agent. Most of the patients adhered to their medications and were satisfied with the treatment received.