Unavailability Of Services Research Articles

Knowledge, Attitudes and Practice Regarding Cervical Cancer and Screening among Women Visiting Selected Primary Health Centres in Ogbomosho, Nigeria

Cervical cancer is one of the most preventable cancers in the world and its` prognosis is better when detected early through cervical cancer screening. The study examined the knowledge, attitudes and practice regarding cervical cancer and screening among women visiting selected primary health centres (PHCs) in Ogbomosho. The study was conducted in May 2021, employing a descriptive cross-sectional design. A sample size of 124 respondents was determined using the Taro-Yamane formula and selected through convenience sampling technique. Data collection utilised a validated questionnaire, with analysis performed using descriptive statistics encompassing frequencies and percentages. Relationships between variables were tested using chi-square at a 0.05 significance level. Findings suggest that more than half (55%) had good knowledge of cervical and cervical cancer screening. The majority (70%) had a good attitude towards cervical cancer and cervical cancer screening. Less than one-third (21%) have had cervical cancer screening done before. Self-reported barriers limiting the practice of cervical cancer screening identified include lack of health education on cervical cancer screening (45.5%), lack of knowledge on the screenings (39.3%), absence of signs and symptoms of cervical cancer (39.3%), low socioeconomic status (29.5%), cost of the procedure (17.9%), unavailability of services (17.9%) and religious beliefs (14.3%). Chi-square analysis showed a statistically significant relationship between the educational status of respondents and their knowledge of cervical cancer screening, likewise, a significant relationship exists between the knowledge of respondents and the practice of cervical cancer screening at P< .05. Conclusively, the study has revealed the practice of cervical cancer screening was found to be low, indicating a disparity between knowledge/attitude and actual screening behaviour, although, knowledge was a key predictor of their screening practices. The way forward is to improve the knowledge of women on cervical cancer and screening via health education while efforts are being put in place to make cervical cancer screening services available at affordable cost.

The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access.

Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N=1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the SupplementaryMaterial.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study.

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps. To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals. Multiexplanatory qualitative case study. Community and hospital cancer clinics in Israel. Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants. Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care. Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Barriers to the implementation of sexual and reproductive health programs for adolescents in Eastern Visayas, Philippines: a thematic synthesis of national policies using a qualitative study.

To review the implementation of essential reproductive health services in Eastern Visayas, Philippines. We reviewed four national policies through a qualitative research design using a series of key informant interviews conducted with service providers and focus group discussions with service beneficiaries. There was a gap between the policies and the implementation of reproductive health services in the Eastern Visayas region. This gap is mainly due to the refusal of service providers to cater to teenagers' needs regarding reproductive health services. This has resulted in teenagers hesitating to seek reproductive health services and related support from primary healthcare facilities. Service beneficiaries have also reported on the unavailability of several reproductive health services in primary healthcare facilities. The gap between national policies and program implementation must be bridged. This can be achieved by creating culturally-specific policies that can improve the implementation of reproductive health programs in the study areas.

The impact of energy poverty on the health and welfare of the middle-aged and older adults.

Drawing upon data from the 2018 CHARLS, this paper utilizes MEPI and a 10% threshold indicator to, respectively, assess the energy poverty (EP) status among middle-aged and older adults in China, focusing on the unavailability and unaffordability of energy services. Additionally, an econometric model is constructed to investigate the effects of EP on the health and welfare of middle-aged and older adults. Regression results indicate that EP exerts a significant negative impact on the health and welfare of middle-aged and older adults. This conclusion remains robust after conducting endogeneity and robustness tests, demonstrating its validity. Finally, based on the calculation results, we propose relevant policy recommendations including enhancing energy services for older adults in rural areas, integrating household energy alternatives with targeted poverty alleviation, enhancing monitoring mechanisms, and conducting energy education activities to alleviate EP and improve the quality of life of middle-aged and older adults.

Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.

How caring communities become part of the health system of the future in the Netherlands. Developments, bottlenecks, and impact.

In the past decade the Netherlands has seen major reforms in health- and social care. These reforms accomplished a shift from a social democratic welfare state to a ‘participation society’; people with care and support need to live at home longer and have to rely on their informal network for support. In order to provide an answer to the retreat of state organized support we see an increase of citizens initiatives for care, wellbeing and support in The Netherlands.
 The growing movement of citizens initiatives, or ‘caring communities, is diffuse. ‘They vary in target groups, activities, organisation and goals. However, they have in common that they are filling the gap care and support provisions that the government has left behind. In order to get a better image of this movement, their impact and the challenges they face in collaborating with the Dutch care system, Vilans and the Dutch umbrella organization of citizens initiatives (NLZVE) bundled their forces in a variety of research projects.
 This collaboration started in 2020 with the ‘Monitor on the Movement of Caring Communities’. In co-creation with key figures from the movement of caring communities we developed a survey. The results of this survey (n=346) gave us insight in the activities, goals, partners and bottlenecks of these initiatives and initiated new participatory action research projects. These focused on reliable and sustainable financing for citizen initiatives, how initiatives measure their impact and how caring communities and ‘system parties’ work together.
 Together with different initiatives we explored different financing models and their pros and cons. The lack of sustainable financing options for citizen initiatives is a bottleneck for the development of these initiatives and for durable collaboration with the system parties. Simultaneously we found that many initiatives struggle to show their impact. This impact is often implied (i.e. less loneliness or a healthier population) but hardly mapped. We found that the lack of a clear message about the impact of an initiative hinders a durable financial model. Municipalities and other financiers need to know what the effect of their investment is. To help the movement of caring communities better map their impact and organize sustainable financing we developed, through co-design, two different tools.
 Another bottleneck for caring communities is the collaboration between these communities and the ‘system’. Caring communities often exist because of discontent with and/or inaccessibility of care and wellbeing services. However, we see that when initiatives want to expand their services (i.e. in the field of home- or social care) they have to collaborate, or in some cases even become part of, the care system. Our project focused on how these worlds come together without both of them losing their strengths and identity. The lessons learned will, together with the survey outcome and both tools, presented during the oral presentation. Additionally we will present our next steps, which include a qualitative and participatory research project on the impact of citizens initiatives and a data driven approach to identify the complete movement of caring communities in The Netherlands.

Unified System for Processing Non-Personalized Data

The purpose of the study. The purpose of this article is to study the possibility of creating a unified register of non-personalized data, that is, data that cannot be attributed to a specific subject of personal data. The objective of the study is to analyze relevant materials for the purpose of the study, to determine the need for this system, to determine possible areas of application of the system, to determine the system sources and data on which the system can be based. The object of the study is a unified system for processing non-personalized data, the issue of creating this system and the opportunities that open up to the user.The subject of the study is the question of the data that can be processed in this system, as well as the section in which the data can be interpreted.Research methods. The article uses the following research methods: analysis of open data sources, modeling of the target solution in the form of a concept.Results. The article presents an example of the implementation of a system for processing non-personalized data. The variants of systems that currently have a set of data on personal data subjects and are ready to conduct a preliminary scoring analysis are presented. A possible result of the application of scoring is presented, using the example of the banking industry. An analysis of the current state of citizens' data processing systems was carried out. The results of the analysis showed that currently there is no single system that would allow for scoring analysis on the subject of personal data, aggregating data from various sources of state systems. There are no data in open sources on the progress of the development of a system that allows for scoring analysis based on non-personalized data. At the same time, the creation of a unified system for processing non-personalized data can both have a positive impact on the economic indexes of consumers connected to it, and contribute to the implementation of strategic plans of the state.Conclusion. During the study, a project was proposed for implementation to create a unified system for processing non-personalized data. A variant of data that can be used for primary scoring is proposed. The advantages of this system include a positive economic effect for organizations connected to the system, due to the reduction of monetary losses, improving the quality of sales, increasing customer loyalty, for the state, a positive effect can be an increase in the transparency of citizens' data and a decrease in the number of economic crimes, for citizens, the positive side of the system is to reduce information noise, due to a decrease in the number of studies from the companies, reduction of fraudulent actions, in relation to consumers. The disadvantages of the system include a high risk of data leakage, as a result of an increase in the number of crimes, incorrect interpretation of data by the scoring model, unavailability of various services for clients of organizations due to lack of data, the risk of data misuse by the operator of personal data processing. As a result, we can conclude that with the proper level of user data protection and clear rules for working with data, this system has good prospects for achieving the economic goals of both private companies and the state.

Enablers and barriers to accessing self-management support services for those living with and beyond cancer: A qualitative study using the theoretical domains framework.

Supporting those living with and beyond cancer to self-manage their health can optimise health-related quality of life and reduce symptom burden. Self-management support (SMS) programmes have been shown to be effective, but uptake is often low. This qualitative study aimed to identify experienced and perceived enablers and barriers to accessing SMS services among those who had completed primary cancer treatment and were living with and beyond cancer. Participants were recruited through social media and cancer advocacy groups. Semi-structured telephone and online interviews were conducted. Transcripts were coded inductively based on participants' reported experiences. Statements related to factors that enable or inhibit access to SMS were then mapped to the Theoretical Domains Framework (TDF). Twenty-six people participated. Six themes explain the factors that act as barriers and enablers which mapped to 11 TDF domains. Lack of knowledge of available SMS was a prominent barrier, as well as inaccessible services due to timing and place of delivery. Lack of confidence and emotional factors including fear were barriers to seeking SMS. Social influences shaped knowledge, attitudes and readiness to access SMS. Perceptions of SMS service goals and if in alignment with self-identity, intentions and goals also shaped decisions around accessing support. While lack of knowledge and provider signposting were common barriers, findings suggest that other psychosocial and emotional factors may be barriers, even if SMS services are accessible. Findings are relevant for oncology healthcare services developing strategies to increase reach of SMS for those living with and beyond cancer.

Gait retraining to reduce falls: an experimental study toward scalable and personalised use in the home

BackgroundAge-related neurological conditions can result in poor mobility typified by gait abnormalities and falls, increasing risk of frailty and lowering quality of life. In the UK, the expense and inaccessibility of services to improve mobility through gait training (eg, auditory cueing) is a public health issue. Contemporary and scalable pervasive technologies for widespread public use could provide an affordable and accessible solution. We aimed to show the preliminary efficacy of a novel smartphone app that provides a personalised approach to mobility and gait assessment while facilitating gait training. MethodsIn this experimental study, we recruited participants aged 22–46 years with no physical functional impairments (ie, no age-related neurological condition and who could walk unaided) from Northumbria University staff (Newcastle upon Tyne, UK) between April 19, and May 26. Participants wore a smartphone on their lower back. Inertial data from the smartphone were recorded during two walks, one at a self-selected pace and the other with a personalised auditory cue via headphones (+10% pace on walk 1). Smartphone app functionality enabled the measurement of clinically relevant gait characteristics via a Python-based Cloud server. We compared smartphone-based mobility or gait characteristics with a gold-standard reference (Opal Mobility Lab, APDM). We used Pearson and intraclass correlation coefficients (ICC2,1) to examine agreement between the novel app and reference. The study ran from April 4 to July 21, 2023. This study received ethics approval from the Northumbria University Ethics committee, and all participants provided written informed consent. FindingsTen adults were recruited (six women and four men; mean age 27·4 years [SD 6·2], mean weight 79·6 kg [SD 12·7], mean height 174·7 cm [SD 7·9]). High levels of agreement were found between the smartphone app and reference, quantified by Pearson (≥0·858) and ICC values (≥0·911). The personalised cueing intervention increased the mean cadence by an average of 11%, which shows good participant adherence to cueing via an app. InterpretationHere, we propose a contemporary approach to increase the accessibility to a health-based intervention. Preliminary findings suggest the smartphone app is a suitable tool for personalised mobility or gait assessment while facilitating gait training. Use of a scalable app could be an accessible and affordable method for improving mobility to reduce falls in the home. Here, current limitations are the lack of investigation with the smartphone app for neurological gait assessment on older adults and the lack of information on participants app experience, but this will be included in future work. The pervasive use of smartphones enables a decentralised approach to overcoming issues such as frailty and logistical challenges of travelling to bespoke clinics. FundingNational Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) North-East and North Cumbria (NENC); Faculty of Engineering and Environment at Northumbria University.

Social determinants of health of Ukrainian female refugees in the Czech Republic

The main aim of the study was to investigate the social determinants of health in the Ukrainian female refugee sample in the Czech Republic. The results showed that some determinants of health like financial difficulties and socioeconomic status decline during forced migration, inaccessibility of healthcare services, health deterioration, the presence of chronic diseases, limitation in daily activity due to ill health, experienced discrimination in host country, lack of a person to share personal feelings and issues were significantly associated with poor self-reported physical health status.

Persistensi Pendampingan Keluarga Terhadap Anggota Keluarga yang Sakit Sebagai Pencegahan Penularan Mycobacterium Tuberkulosis di Serdang Bedagai

The increasing burden of TB is caused by poverty, the failure of TB activities which has been caused by inadequate political commitment and funding, the unavailability of services in the community causing reduced problem innovation and inappropriate diagnosis, reduced supply of medicines and reduced reporting of tuberculosis sufferers, lack of surveillance, minimal discourse on recording and reporting cases, treatment management and unreported movement of people. The method used was descriptive observational with 20 participants who were families of tuberculosis sufferers at the Serdang Bedagai health center. The PkM team provided the material in question: 1) Understanding family persistence, 2) The importance of family in accompanying TB sufferers, 3) How to prevent transmission, and 4) Patient compliance in taking medication. Results after carrying out the activity 1) Understanding family persistence, the majority of them were good, 18 people, 2) The importance of families accompanying TB sufferers, the majority of them were good, 19 people, 3) Ways to prevent transmission, the majority were good, 19 people, 4) Compliance with patients in taking medication, the majority were good, 19 person. The persistence of family assistance to sick family members as a means of preventing the transmission of mycobacterium tuberculosis shows improvement and skills because people have a great desire to treat and prevent the occurrence of tuberculosis in family members at home.

A Study on the Influencing Factors of Deaf Peoples Medical Behavior and Attitude in Shanghai

During an emergency medical treatment experience, one of our team members saw a deaf person with heart discomfort who could not express his condition to the doctor and felt anxious and helpless and thus began to pay attention to the medical treatment of deaf people. In the preliminary research, the team found that the medical treatment process and experience of deaf people are inconvenient. Some deaf people show more negative medical treatment behavior and attitude. Therefore, on this basis, the research question of this paper is further proposed: what are the difficulties and obstacles existing in the current medical treatment of deaf people? What factors influence the medical treatment behavior and attitude of deaf people? Taking the deaf-dumb people in Shanghai as the research target, this paper conducts a relevant investigation utilizing a questionnaire, semi-structured interview, and participatory observation. A total of 148 questionnaires were collected, and ten deaf patients, volunteers, and professionals from deaf organizations were interviewed for interviewing method. The team members also launched a participatory observation by volunteering at the deaf and hard-of-hearing outpatient clinic. This study found that some deaf people in Shanghai have negative attitudes and behaviors toward medical treatment, mainly manifested as reluctance to see a doctor in time, fear of going to the hospital, and distrust of the medical system and doctors. The main reasons for this problem are as follows: poor communication quality, low self-confidence, poor financial conditions, doctors negative attitudes, unavailability of voice services, and lack of volunteers. With the development of digital media in recent years, the difficulties in diagnosing and treating deaf patients have been alleviated.

Characteristics of employment history and self-perceived barriers to healthcare access.

Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators. We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics. Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators. Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.

Service delivery inaccessibility as a predictor of teenage pregnancy in South Africa.

With the onset of the South African democracy in 1994 it was hoped that many social inequalities would be addressed urgently. However, studies have shown that service delivery inaccessibility remains a challenge and investigating the social implications of such injustices remains important. This study determined to establish the association between service delivery inaccessibility and adolescent pregnancy in South Africa. Using data from 2019 and 2021 general household surveys, 7 737 teenage females were included. The study applied descriptive statistics, chi-squared testing as well as multilevel binary logistic regression. Random-intercept multilevel binary logistic regression revealed that the risk of adolescent pregnancy independently increased as the level of service inaccessibility increased at household level (no services: OR=1.73, 1 service: OR=1.40, 2 services: OR=1.28) and community level (medium: OR=1.22, high: OR=1.38) at a P-value of 0.05. Findings highlight the need to guarantee universal service delivery urgently not only for development, but also to prevent adolescent pregnancy. Furthermore, the findings present evidence of structural factors driving adolescent pregnancy in South Africa, which renders continued cycles of poverty, injustice and early pregnancy amongst the majority of Blacks.

The Impact of the Pharmaceutical Ecosystem in Achieving Universal Health Coverage in Sub-Saharan Africa

Background: The purpose of universal health coverage (UHC) is to provide equitable access to health services to people without financial hardship. Nevertheless, despite the diverse measures in place to accomplish this goal, there are still obstacles including access to affordable essential medicines. Specifically, low and middle-income regions like Sub-Saharan Africa and South Asian countries are the most affected due to regional disparities in achieving UHC. Citizens in financially vulnerable positions in these nations rely on their governments to provide essential medicines at little or no cost. However, government health systems are plagued with the unavailability of necessary medicines and services, forcing citizens to resort to more expensive private options and placing them at greater financial risk. The pharmaceutical ecosystem is responsible for the research, development, manufacturing, distribution, regulation, and safe use of these medicines. This study reviewed the impact of the pharmaceutical ecosystem in achieving universal health coverage in Sub-Saharan Africa. Method: A narrative review of published peer-reviewed articles and grey literature was executed to examine how the pharmaceutical ecosystems have impacted universal access to the use of medicines thus achieving universal health coverage. Conclusion: The pharmaceutical ecosystem sector is complex and crucial in achieving Universal Health Coverage as it directly affects the accessibility of safe, effective, and affordable essential medicines. Pharmacists are the major drivers of this ecosystem and should build their capacity in this area for positive results to be achieved in improving access to medicines and reducing the global disease burden. In Sub-Saharan Africa, due to the lack of government structures and enforcement, sectors of this ecosystem operate sub-optimally, and players and actors have taken advantage of its weaknesses and disorganization. Therefore, further research is imperative to identify ways to progress and improve the pharmaceutical ecosystem.

The impact of the COVID-19 pandemic on trends in stillbirths, under-5 and maternal mortality in Brazil: Excess deaths and regional inequalities.

Despite the proliferation of studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic, there is less evidence on the indirect death toll compared to the health system and service provision disruptions. We assessed the impact of the COVID-19 pandemic on national and regional trends and differences in stillbirths, under-5 and maternal deaths in Brazil. We used the nationwide routine health information system data from January 2017 to December 2021, to which we applied descriptive and advanced mixed effects ordinary least squared regression models to measure the percent change in mortality levels during the COVID-19 pandemic (March 2020 to December 2021). We carried out counterfactual analyses comparing the observed and expected mortality levels for each type of mortality at national and regional levels. Stillbirths increased 4.8% (3.1% in 2020 and 6.2% in 2021) and most noticeably maternal deaths increased 71.6% (35.3% in 2020 and 103.3% in 2021) over the COVID-19 period. An opposite pattern was observed in under-5 mortality, which dropped -10.2% (-12.5% in 2020 and -8.1% in 2021). We identified regional disparities, with a higher percent increase in stillbirths observed in the Central-West region and in maternal deaths in the South region. Based on pre-pandemic trends and expected number of deaths in the absence of the COVID-19, we observed increases in stillbirths and maternal deaths and reductions in under-5 deaths during the pandemic. The months with the highest number of deaths (stillbirths and maternal deaths) coincided with the months with the highest mortality from COVID-19. The increase in deaths may also have resulted from indirect effects of the pandemic, such as unavailability of health services or even reluctance to go to the hospital when necessary due to fear of contagion. In Brazil, the COVID-19 outbreak and subsequent restrictions had a detrimental impact on stillbirths and maternal deaths. Even before the pandemic, mortality trends highlighted pre-existing regional inequalities in the country's health care system. Although there were some variations, increases were observed in all regions, indicating potential weaknesses in the health system and inadequate management during the pandemic, particularly concerning pregnant and postpartum women.

Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria

IntroductionNigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.MethodsThis is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant’s EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).ResultsTwenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems’ challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.ConclusionsThere is a need to expand EID services and address women’s denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.

Understanding Female Patients' Knowledge, Attitudes, and Practices Regarding Cervical Cancer Screening at Comboni Hospital

Cervical cancer stands as the leading cause of cancer-related deaths among women in Uganda, with a prevalence rate of 48/100,000, one of the world's highest. Tragically, over 80% of cases are diagnosed at an advanced stage, limiting treatment options. Early detection through screening among women aged 25 and above, followed by prompt treatment, can prevent most cases. This study aimed to assess knowledge, attitudes, and practices concerning cervical cancer screening among female patients at Comboni Hospital. Conducted as a cross-sectional descriptive study, it involved 350 women aged 20-49 seeking healthcare services at the hospital. Data collection employed a pretested questionnaire, and analysis utilized IBM SPSS version 25. The respondents, with a mean age of 31.73 years, were predominantly married (76.6%) and self-employed (42.9%), with 22.3% having completed tertiary education. While 92.3% were aware of cervical cancer, only 46% had contemplated undergoing screening, and merely 26.3% had been screened. Media served as the primary information source for 53.7% of participants, and half of those screened did so due to healthcare workers' advice. Barriers to screening included high costs (27.7%), fear of positive results (14.6%), and apprehension about the screening process itself (14.3%). Despite a high level of awareness about cervical cancer, low screening uptake was attributed to the expense and unavailability of services. To improve access, the government should decentralize screening services to lower-tier health centers by training and equipping lower-level healthcare workers, particularly midwives. This strategy aims to overcome barriers and enhance screening accessibility for a larger population. Keywords: knowledge, attitude, practice, cervical cancer.

Violence against women during the Covid-19 Pandemic: Scoping review of the literature in collaboration with the World Health Organization protocol

The World Health Organization estimates that almost one in three women were subjected to physical and/or sexual intimate partner violence or sexual violence by someone other than their partner at least once in their lifetime. During the COVID-19 pandemic, there were increased reports of violence against women in some countries, whereas others reported reductions, in part due to inaccessibility of services. The aim of this scoping review is to first document the available research evidence on violence against women during the COVID-19 epidemic, both in terms of its impact on violence against women and how it was addressed through services and interventions. This scoping review will begin with a search of six databases, using search strategies developed by the review team: MEDLINE, PsycINFO, Social Science Citation Index–expanded, Cochrane Library (including CENTRAL), Campbell Systematic Reviews Journal, and Scopus. Predefined inclusion and exclusion criteria will be applied to identified studies to determine eligibility as part of a two-stage process (title and abstract; full text). Following data screening, data from included studies will be synthesised and presented in descriptive, tabular format and accompanied by a narrative description of the characteristics of those studies and their findings. The findings of this review will contribute to ongoing efforts of the World Health Organization to build evidence on how outbreaks like COVID-19 impact violence against women and identify strategies to address this and ensure access to services is protected. The scoping review will facilitate a follow-on deeper analysis of the available evidence through systematic review methods.