Skilled Health Care Providers Research Articles

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Unveiling women's lived experiences with care provided by a pregnancy heart team: A qualitative phenomenological study.

The purpose of this study was to gain an in-depth understanding of the lived experiences of women with CVD regarding their care by a pregnancy heart team (PHT) during pregnancy and the immediate postpartum period. Using a qualitative phenomenological study, data were collected through semi-structured interviews with 13 women receiving follow-up care from a PHT at a large tertiary center. Data were collected between December 2022 and September 2023, and thematic content analysis was conducted. The lived experiences of women with CVD were reflected in the PHT by two main themes: "emotional distress" and "(dis-)organization of care." The "emotional distress" theme had sub-themes of "awareness and impact of CVD on pregnancy," "loneliness," and "need for psychological support." The theme of "(dis)organization of care" was expressed through the sub-themes of "(dis-)continuity of care" and "(expected) skills of healthcare providers." The current study findings highlight the impact of CVD on pregnancy and the emotional challenges faced by women with CVD during the course of their pregnancy. Improvements in accessibility, timeliness, reciprocity and shared decision-making, and psychological support could contribute to more patient-centered care.

Pattern Of Admission And Outcome Among Neonates Admitted Into The Special Care Baby Unit Of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: The neonatal disease pattern is a sensitive indicator of the availability, utilisation and effectiveness of mother and child health services in the community. Community based data are difficult to come by, so hospital based data most often is use to assess the burden of neonatal problems. Aim: To determine the pattern of morbidity, mortality and outcome of neonates admitted into the Special Care Baby Unit (SCBU) of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto from 1 st January 2022 to 31st December 2022. Methods: A hospital-based retrospective review of medical records of neonates admitted into the SCBU of UDUTH, Sokoto from 1 st January, 2022 to 31st December, 2022. Information retrieved included the biodata, place of birth, age at admission, diagnosis, duration of hospital stay and outcome. Data was analysed using SPSS version 22. Results: A total of 818 neonates were admitted during the study period, 393(48.0%) were males and 425(52.0%) were females giving a male to female ratio of 1:1.1. Most 606(74.1%) of the patients were out born. Birth Asphyxia 245(30.0%) was the main reason for admission, followed by prematurity 182(22.3%). Majority 653(79.2%) were discharged, 16(2.0%) left against medical advice, while 149(18.2%) of the admitted patients died. Prematurity related death 61(40.9%) and birth Asphyxia were the leading causes of death respectively. Majority 107(71.8%) of the deaths occur among the out-born. Conclusion: Birth asphyxia and prematurity related complications were the main reasons for neonatal admissions and the leading causes of death in this study. Most of the neonatal deaths were from preventable causes. Strengthening perinatal care, emergency obstetric services, facilities for improved preterm care should be provided in secondary and tertiary health facilities and improving the skills of health care providers on neonatal resuscitation are necessary to reduce neonatal mortality

Does living in major towns favor institutional delivery in Somalia?

In developing countries, institutional delivery is a key proven intervention that reduces maternal mortality and can reduce maternal deaths by approximately 16%-33%. In Somalia, only 32% of births are delivered in a health facility with the assistance of a skilled healthcare provider. We aimed to investigate the factors hindering women from giving birth at healthcare facilities in major towns in Somalia, where most of the health facilities in the country are concentrated. A community-based health survey was carried out in 11 major towns in Somalia between October and December 2021. A structured and pretested questionnaire was used to collect data from 430 women who gave birth in the last five years. Women were recruited through convenient sampling. Descriptive statistics were used to summarize the data, and binary and multivariable logistic regression analysis was performed. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the associations. The overall prevalence of institutional delivery was 57%. Approximately 38% of women living in Mogadishu and 53% living in another ten towns give birth at home. Women who had poor knowledge of the importance of health facility delivery had nearly four times higher odds of delivering at home (AOR 3.64 CI: 1.49-8.93). Similarly, those who did not receive antenatal care (AOR 2.5, CI: 1.02-6.39) and those who did not receive a consultation on the place of delivery (AOR 2.15, CI: 1.17-3.94) were more likely to give birth at home. The reasons for home delivery included financial reasons, the long distance to the health facility, and the fact that it was easier to give birth at home. The study found that home delivery is high in major towns in Somalia and is associated with a lack of understanding of the importance of health facility delivery, not using ANC, and not receiving consultancy about where to give birth. Primary health care should strengthen information, education, and communication activities. Since the health care system in Somalia is overwhelmingly private, the government may consider access to free and within-reach ANC and health facility delivery for women and girls from families who cannot pay the ANC and childbirth delivery cost.

Level of optimal antenatal care utilization and its associated factors among pregnant women in Arba Minch town, southern Ethiopia: new WHO-recommended ANC 8+ model.

To fully realize the life-saving and health-promoting benefits of antenatal care (ANC), the latest World Health Organization (WHO) recommendations call for pregnant women to have at least eight contacts with skilled healthcare providers. This increased number of recommended ANC visits represents a shift toward a more comprehensive, individualized approach to prenatal care. The focus is on health promotion, disease prevention, and the early detection and management of complications during pregnancy. However, in sub-Saharan African countries, including Ethiopia, the coverage rate for this level of recommended antenatal care is only 58%. Given this relatively low utilization, identifying the key risk factors that prevent adequate antenatal care would have significant implications for increasing overall ANC uptake in these regions. The aim of the present study was to assess the level of optimal antenatal care utilization and its associated factors among pregnant women in Arba Minch town, southern Ethiopia in 2023 using the new WHO-recommended ANC 8+ model. An institution-based cross-sectional study was conducted among 416 mothers who were enrolled between 1 December 2022 and 30 January 2023. The total sample size was allocated proportionately to the number of women who delivered at each public health facility. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using SPSS Version 26. Statistical significance was determined at a p-value <0.05. In this study, the level of optimal antenatal care was 41% [95% confidence interval (CI): 37-45.3]. The associated factors with optimal antenatal care were the presence of pregnancy danger signs [adjusted odds ratios (AOR) = 4.1, 95% CI: 1.87-8.82], having bad obstetric history (AOR = 3.90, 95% CI: 1.94-7.83), antenatal contact at hospital (AOR = 5.11, 95% CI: 2.28-11.21), having good knowledge about antenatal care (AOR = 2.26, 95% CI: 1.15-4.44), women's high decision-making power (AOR = 3.9, 95% CI: 1.2-7.63), and male partner involvement (AOR = 2.0, 95% CI: 1.04-3.78) were positively associated with optimal antenatal care utilization. The level of optimal antenatal follow-up is still low. Therefore, it is crucial to provide more information during the antenatal contacts to lower the rate of women discontinued from antenatal care.

PATRONAGE OF ANTENATAL CARE SERVICES IN ZAMFARA STATE, NIGERIA

Utilisation of antenatal care (ANC) services by women during pregnancy plays a pivotal role in averting pregnancy related morbidity and mortality. However, utilisation of the services remains low over the years in Nigeria and Zamfara State, in particular. This study examined the patronage of ANC services in urban, semi-urban and rural areas of Zamfara State, Nigeria. Quantitative data were used for the study. A total of 384 copies of questionnaire were administered to women of child-bearing age that had children under-five, using the Multistage Cluster Sampling technique. The Statistical Package for Social Sciences (SPSS) version 21 was used for the data analysis. The Health-Seeking Behavior model developed by Ronald Max Anderson was adopted as the theoretical framework for the study. The study discovered that majority of mothers received ANC services from skilled healthcare providers at least, once, but the utilisation of the specific components of the services was low. Majority of the respondents did not comply with the current 8 ANC Visits, did not take folic acid and iron tablets daily and had not HIV test during pregnancy. Some women did not use the services at all due to reasons including lack of husband/ mother in-law’s permission, patronage of traditional birth attendants, lack of interest, not experiencing any pregnancy related illness, distance to healthcare facility, transportation problems, insecurity and poverty. The study recommends that the Zamfara State government should ensure availability, affordability and accessibility of ANC drugs at all government health facilities. The policy of compelling pregnant women to patronize ANC services as well as carrying out mobilization and enlightenment campaigns throughout the State at regular intervals, should be encouraged.

Recovery Rate and Predictors for Cure of Admitted COVID-19 Patients in Ethiopia; A Systemic Review and Meta-Analysis

BACKGROUND. Despite the global efforts to curb COVID-19 infection using vaccines and drugs, the burden of illness, hospitalization, and death are continued as a deadly pandemic. Previous study finding estimated recovery time of 2 weeks for mild and 3 to 6 weeks for hospitalized cases. However, in low and middle-income countries like Ethiopia, recovery rate and viral negative conversion time are lowballed and underestimated due to the new variant incidence, limited resources and lacked skilled healthcare providers for admitted COVID-19 patients. This study aimed to estimate pooled recovery rate, and predictors for cure among admitted COVID-19 patients in Ethiopia. METHODS. Five electronic databases (Medline, PubMed, HINARY, Africa Journals Online, and Google Scholar) were searched. A total of 529 articles were extracted from cohort studies published in English spanning from December 30, 2019, to December 30, 2023. PRISMA guidelines were adhered to articles screening and extracted using Microsoft Excel. The quality of eligible articles was evaluated using the JBI checklist. The pooled effect size and adjusted odds ratio (AOR) with 95% confidence intervals were determined using the random-effect meta-regression using STATA version 17. Heterogeneity among studies was assessed using Cochran's Q-test, and the variation was estimated by I2, and presented in a forest plot. Subgroup analysis was also used to identify sources of heterogeneity among studies. RESULT. A total of 12 studies were included in the final meta-analysis. During the recovery screening of 5,152 admitted COVID-19 cases, 4,411 participants were discharged as cured. The pooled recovery rate was estimated at 90.6% (95% CI: 87.1-94.23, I² = 96.11%, P = 0.001). In subgroup analysis, Addis Ababa exhibited the highest recovery rate with 95.1%, followed by Oromia (94.6%), and Southern nation nationalities (SNN) region (91.55%). The recovery rate was higher for individuals aged 15-30 years (AHR = 2.01, 95% CI: 1.41-2.86, P = 0.001), males’ gender (AHR=1.46, 95% CI: 1.14-1.88, P=0.002), and cases admitted with ≥37.5°C (AHR = 2.01, 95% CI: 1.41-2.86, P = 0.001) compared to their counterparts. This manuscript is ongoing a submitted for registered in Prospero. CONCLUSION. In Ethiopia, nearly nine in every ten (90%) admitted COVID-19 cases recovered. However, the recovery rate exhibits a significant variation across each study region, setting, and pandemic phase. Therefore, healthcare providers prioritize care for critical cases to increase the overall survival rate of admitted patients.

Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

Use of family planning information by primary healthcare clinic managers in South Africa.

Routine family planning data in South Africa are managed using a routine health information system, which facilitates data collection, storage, processing, presentation and dissemination. Healthcare providers generate data daily as they carry out their duties. The information generated should be used for planning and evaluating health program performance and policy development. To explore the use of family planning information by primary healthcare (PHC) clinic managers in South Africa. A qualitative descriptive exploratory study was carried out in 11 PHC clinics in Tshwane District. Individual semi-structured interviews were conducted with 11 clinic managers. The data were analysed using a thematic analysis approach. Managers used the information to disseminate performance and feedback, monitor the program's performance and make decisions to improve the family planning service. However, they experienced challenges that hampered the effective use of the information. The use of family planning information is critical for improving the performance of the program. The clinics need sufficient skilled healthcare providers who are able to provide comprehensive family planning and generate accurate and reliable information that can be used to improve the service. Collaboration between the private and public sectors is critical in monitoring the program's performance.

Knowledge and skills of newborn resuscitation among health care professionals in East Africa. A systematic review and meta-analysis.

Newborn resuscitation is a medical intervention to support the establishment of breathing and circulation in the immediate intrauterine life. It takes the lion's share in reducing neonatal mortality and impairments. Healthcare providers' knowledge and skills are the key determinants of the success of newborn resuscitation. Many primary studies have been conducted in various countries to examine the level of knowledge and skills of newborn resuscitation and associated factors among healthcare providers. However, these studies had great discrepancies and inconsistent results across East Africa. Hence, this review aimed to synthesize the pooled level of knowledge and skills of newborn resuscitation and associated factors among healthcare providers in East Africa. Studies were systematically searched from February 11, 2023, to March 10, 2023, using PubMed, Google Scholar, HINARI, and grey literature. The effect size measurement of knowledge and skill of health care newborn resuscitation was estimated using the Random Effect Model. The data were extracted by Excel and analyzed using Stata 17 software. The Cochran's Q test and I2 statistic were used to assess the heterogeneity of studies. The symmetry of the funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was done on the study years, sample sizes, and geographical location. Percentages and odds ratios (OR) with 95% CI were used to pool the effect measure. In this systematic review and meta-analysis, a total of 1953 articles were retrieved from various databases and registers. Finally, 17 studies with 7655 participants were included. The overall levels of knowledge and skills of healthcare providers on newborn resuscitation were 58.74% (95% CI: 44.34%, 73.14%) and 46.20% (95% CI: 25.16%, 67.24%), respectively. Newborn resuscitation training (OR = 3.95, 95% CI: 2.82, 5.56) and the availability of newborn resuscitation guidelines (OR = 2.71, 95% CI: 1.90, 3.86) were factors significantly associated with knowledge of health care professionals on newborn resuscitation. Work experience (OR = 5.92, 95% CI, 2.10, 16.70), newborn resuscitation training (OR = 2.83, 95% CI, 1.8, 4.45), knowledge (OR = 3.05, 95% CI, 1.78, 5.30), and the availability of newborn resuscitation equipment (OR = 4.92, 95% CI, 2.80, 8.62) were determinant factors of skills of health care professionals on newborn resuscitation. The knowledge and skills of healthcare providers on newborn resuscitation in East Africa were not adequate. Newborn resuscitation training and the availability of resuscitation guidelines were determinant factors of knowledge, whereas work experience, knowledge, and the availability of newborn resuscitation equipment and training were associated with the skills of healthcare providers in newborn resuscitation. Newborn resuscitation training, resuscitation guidelines and equipment availability, and work experience are recommended to improve healthcare providers' knowledge and skills.

Implementing evidence-based pre-operative education in hospitalized patients undergoing total knee replacement: a best practice implementation project

ABSTRACT Introduction: Pre-operative education is a key factor influencing post-operative recovery, patient expectations of surgery, and patient satisfaction. Although there are guidelines for the pre-operative education of patients undergoing knee replacement, pre-operative education of patients remains suboptimal. Objectives: This study aimed to improve the knowledge and skills of health care providers and patients undergoing elective knee replacement. The project used pre-operative education to increase compliance with best practices. Methods: This project was conducted from January to October 2022 in the orthopedic department of a tertiary hospital in China. The project was conceptually guided by the JBI Model of Evidence-Based Healthcare, while the JBI Evidence Implementation Framework was used to guide the implementation. Two audit criteria were developed for the baseline and follow-up audits, which assessed 20 patients undergoing elective knee replacement. Results: A comparison of the audit outcomes revealed that for Criterion 1, the percentage of patients receiving pre-operative education in both audits was 100%. For Criterion 2, the compliance rate increased significantly from 0% in the baseline audit to 90% in the follow-up audit. Conclusions: A clinical audit is an effective approach to improving compliance with recommended best practices. Leadership, team resource management, education, and monitoring were helpful in implementing the best practices. Further audits will need to be conducted to maintain practice changes and ensure that the project is sustainable.

Practice of Birth Preparedness and Complication Readiness and Its Associated Factors:A Health Facility-Based Cross-Sectional Study Design.

Time of labor or time of emergency is not the time to decide what to do, instead it is time to seek care from skilled health care providers. Birth preparedness and complication readiness is the process of planning for a normal birth and anticipating the action needed in case of an emergency, which helps to minimize obstetric complications. Even though birth preparedness and complication readiness reduce maternal and newborn morbidity and mortality, the practice of birth preparedness and complication readiness is still low in Ethiopia. This study aimed to assess the practice of birth preparedness and complication readiness and its associated factors among pregnant women who attended antenatal care in the public health facilities of Debre Tabor town, northwest, Ethiopia. A health facility-based cross-sectional study was conducted from August 1/2022 to September 15/2022 among 397 pregnant mothers. The study was collected using a systematic random sampling technique and the collected data were entered and analyzed using SPSS version 25.0. Bivariate and multivariate logistic regression analyses were employed to estimate the crude and adjusted odds ratio and considered significant at a confidence interval of 95% and a P-value of less than .05. The proportion of birth preparedness and complication readiness practice was found to be 32.2%. Having formal education, primigravida, starting antenatal care contact in the first trimester of pregnancy, having knowledge of danger signs of labor and delivery, and birth preparedness and complication readiness were significantly associated with the practice of preparedness and complication readiness. In this study area, the practice of birth preparedness and complication readiness was low. Therefore, it is important to strengthen counseling on the advantage of starting antenatal care contact early and creating awareness of birth preparedness and complication readiness.

The nexus between geographical distance and institutional delivery trends in Ethiopia: evidence from nationwide surveys.

Giving birth in a healthcare facility with the guidance of skilled healthcare providers allows access to necessary medical interventions. Ethiopia has implemented several strategies to enhance institutional delivery and decrease maternal mortality; however, the rate of institutional delivery remains low. This study examines the role of distance to healthcare institutions on institutional delivery in Ethiopia, and how this has changed over time. This study used data from two rounds of the Ethiopian Demographic and Health Survey (2011 and 2016), a spatial database detailing the locations of healthcare facilities, and Ethiopian road network data. The sample included 22,881 women who delivered within the 5 years preceding each survey and lived in 1,295 villages. Bivariate and multivariable logistic regression analyses were used to investigate how the distance to health facilities and other potential determinants influenced institutional delivery trends. The rate of institutional deliveries in Ethiopia has increased from 10% in 2011 to 26% in 2016. Likewise, the average transportation distance to health facilities has decreased from 22.4 km in 2011 to 20.2 km in 2016 at the national level. Furthermore, a one-kilometer increase in the distance to the nearest health facility was associated with a 1% decrease in the likelihood of delivering at a health facility in 2016 (odds ratio (OR) = 0.99, 95% CI [0.98-0.99], p < 0.05). Additionally, mothers who are more educated, have completed more antenatal care visits, live in wealthier households in more urban areas, and cohabit with more educated husbands are more likely to deliver at healthcare facilities. These variables showed consistent relevance in both survey rounds, suggesting that key determinants remained largely unchanged throughout the study period. The impact of distance from health facilities on institutional delivery in Ethiopia remains evident, although its influence is relatively modest. The other factors, including education, antenatal care, socioeconomic status, urban residence, and partner education, remained consistent between the two surveys. These determinants have consistently influenced institutional delivery, highlighting the importance of a comprehensive approach that addresses both access to and socioeconomic factors to improve maternal and infant health across the country.

Concept mapping brainstorming results for improving care transitions for adults with hip fracture in Ontario, Canada

Introduction: Individuals who have experienced a hip fracture often undergo numerous transitions in care between providers and sectors. These transitions are a time of vulnerability with the potential for poor health outcomes and experiences, yet there are limited recommendations on how to improve this care journey for adults with hip fracture.&#x0D; Target Audience: The target audience for our study include decision-makers and providers with a hip fracture portfolio, as well as patients who have experienced a hip fracture and their unpaid caregivers. &#x0D; Who was involved: This study included patient and caregiver partners. They were involved in the grant application, study participant recruitment, data collection, and final data analysis. This study also included healthcare provider and decision-maker partners who supported participant recruitment and will be knowledge users. &#x0D; Aims and Methods: The aim of this study was to create a list of actionable recommendations to improve care transitions for individuals with hip fracture from the perspectives of patients, caregivers, providers, and decision-makers. We used a mixed methods concept mapping approach, to gather perspectives from these key stakeholders in Ontario, Canada. Here, we report on the results of the first phase of the concept mapping study. Participants created a list of statements that they felt would improve care transitions for individuals who had experienced a hip fracture. The statements were analyzed inductively and grouped thematically. &#x0D; Results: Thirty-two individuals participated in the brainstorming phase of this study (2 patients, 5 caregivers, 21 providers, 4 decision-makers). They created 887 statements that were condensed by the research team into 72 final statements. The final statements were grouped into seven main themes and were divided into four domains for care transition improvement. The first is the patient-related domain, which encompassed two themes: self-management and self-management-support, and rehabilitation therapy and activities. The second domain is provider-related and includes: healthcare provider skills and communication and trust. The third domain includes two system-related themes: continuity of care and health system efficiencies. The last domain relates to care processes with one theme: transition planning and follow up care. &#x0D; Learnings for the international audience: Previous literature on improving care transitions has had focused primarily on the transfer of information between care providers with little emphasis on the caregiver/patient role. Our results, however, highlight the importance of meaningful patient and caregiver engagement, with active involvement in all aspects of care including the transition process. Further, many statements created by our participants included policies, assessments, and care specific to individuals with hip fracture and cognitive impairment/delirium, emphasizing this as an important area for consideration when aiming to improve care transitions. &#x0D; Next Steps: The next phases of concept mapping will be conducted, which will include statement sorting and rating (importance and priority). A final concept mapping session will be held integrating the qualitative and quantitative data and an opportunity to reflect on the findings with key stakeholders. Statements that are rated highly importance and priority will inform actionable recommendations to improve care transitions for hip fracture.

Assessing Healthcare Provider's Skills in the Management of COVID-19 Infection at Busia County Referral Hospital, Kenya

Context: The zoonotic coronavirus of 2019 (COVID-19) was caused by an enveloped Ribonucleic Acid (RNA) virus from the Coronaviridae family in the Sarbecovirus subgenus and Severe Acute Respiratory Syndrome – Coronavirus – 2 (SARS-Cov-2) organism. The index case was believed to have originated and transmitted from animals (bats) to humans in November 2019 at the Wuhan live market in China, and subsequently, transmissions were among the human race through direct and indirect contact with respiratory droplets from an infected person(s) to the vulnerable person(s), while talking, sneezing, or coughing. World Health Organization (WHO) declared it a pandemic on March 11, 2020, while in Kenya, it was on March 20, 2020, and by June 11, 2021, Busia County had 3,982 infected individuals, with a positivity rate of 3.9%, 157 being health care providers across all cadres were infected and two deaths reported. Busia County Referral Hospital contributed 30% of the total infected healthcare providers across the seven sub-counties due to non-adherence to standard and transmission-based precautions as guided by the World Health Organization.&#x0D; Aim: The study assesses the healthcare provider's skills in managing COVID-19 infection at Busia County Referral Hospital in Kenya.&#x0D; Methods: The study utilized a descriptive cross-sectional study design, using a semi-structured questionnaire to collect qualitative and quantitative data from 153 study subjects stratified per cadre. The data collection tool was adapted from the facility readiness assessment questionnaire for COVID-19 (Centre for Disease Control and Prevention) and the risk assessment and management of exposure questionnaire of healthcare workers in the context of COVID-19 (World Health Organization).&#x0D; Results: The study reveals that respondents who had worked for shorter duration (1 to 3 years) and were taken through shorter training sessions (1 to 2 days) had higher odds 2.3 and 2.1 (p = 0.03) and p=0.04), respectively to demonstrate good skills in the management of COVID-19, which was statistically significant. Furthermore, knowledge of five moments of hand hygiene had p=0.007, with a higher odds ratio on availability of essential commodities such as gloves 2.5 odds, surgical face masks 3.8 odds, thermos-gun 3.8 odds, designated focal person at triage 6.1 odds and screening checklist 3.2 odds with p-value ≤ 0.05 enhanced good skills required to curb the pandemic.&#x0D; Conclusion: Frequent shorter periods of training of the health care providers and the availability of essential commodities for managing COVID-19 enhanced good skills to curb the pandemic infection. Knowledge of the five moments of hand hygiene influences good skills to prevent the spread of COVID-19 infection. The study recommended regular drills on appropriate use of personal protective equipment and adherence to five moments of hand hygiene by healthcare providers as key skills in managing COVID-19 infection. It further recommends establishing and disseminating policy on an essential list of health products and technologies required to manage COVID-19. In addition, the study recommends a further in-depth study on the impact of the mitigation strategies put in place to manage the pandemic.

Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article.

Antenatal care (ANC) is provided by skilled healthcare professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy. It includes risk identification, prevention, management of pregnancy-related diseases, health education, and health promotion. Antenatal care has a great effect on vital health indicators such as maternal and neonatal mortality by identifying and treating pregnancy-related complications. Political instability and armed conflict have seriously affected the health system, which has catastrophic implications for pregnant women's health. This review aimed to summarize the literature on ANC in Sudan before and during political instability and war by highlighting its effect on maternal mortality, coverage, care providers, quality of care, accessibility, and utilization. Other aspects of this review are the ANC components and service provision during the war. In addition, the author tried to identify the gaps and point out the future research needs in Sudan. A total of 58 articles about ANC in Sudan have been reviewed through PubMed, Google Scholar, ResearchGate databases, and other search tools. The keywords used were "antenatal care", "coverage", "service providers", "service quality", "accessibility and utilization", "components", and "ANC during the war". All the keywords were followed by "Sudan" to confine the search. According to the reviewed data, ANC services in Sudan, even during normal political situations, were not sufficient and of poor quality in most of the reviewed regions. The political instability and armed conflicts worsened the situation, and it became catastrophic. To improve the accessibility and quality of ANC services, we will need the collaboration of all stakeholders to address the health needs of vulnerable groups, people in remote rural areas, and nomadic communities towards providing the required health services in general and ANC in particular. On the other hand, an important aspect of this development is the availability of skilled healthcare providers and the adoption, revision, and updating of working procedure guidelines to match the needs of the local communities. The main shareholders are the local communities; they must be empowered and involved by raising their awareness. Then, effective, punctual, and applicable contingency plans should be ready for any unfortunate crises.

Knowledge, attitude and practice of self-administered insulin by diabetes mellitus patients: A cross sectional study

Diabetes mellitus is a heterogeneous clinical syndrome secondary to defects in insulin secretion, action, or both. India is emerging as the world's diabetic capital. Inadequate awareness about the use of insulin is likely to influence its acceptance and adherence. To assess the knowledge, attitude, and practice (KAP) of self-administered insulin by patients of diabetes mellitus. It was a cross-sectional study conducted by the department of pharmacology at a tertiary care teaching hospital over a period of six months at the medicine outpatient department. A prevalidated questionnaire was used to assess the KAP of insulin use. Informed consent was obtained from the patients prior to giving them a questionnaire. Among the 151 responses, 58 were male and 93 were female. Among them, 66% knew about different types of insulin, and 32% knew about different insulin delivery devices. Around 40% of patients were not aware of HbA1c as a monitoring tool. Nearly 48% patients knew the complications of diabetes. Half of the patients were confident about the self-administration of insulin. About 54% patients took insulin for treatment. Among current insulin users, 75% injected insulin at the upper arm, 83% missed insulin doses, 74% had never used a glucometer, and 32% failed to rotate the site. Knowledge and attitude were good in the majority of patients, but practice regarding the use of insulin was poor. Skilled health care providers could educate diabetes mellitus patients on self-care management and insulin self-therapy and bridge this gap.

Public satisfaction with health system after healthcare reform in China

BackgroundThe Chinese central government launched the third phase of health system reforms in 2009. After a decade since the initiation of the reform, the health system has witnessed noteworthy gains. However, there is no concurrent improvement in public satisfaction with the health system. This study analysed various factors that influence public satisfaction with the system and examined whether perceived quality of care affects public satisfaction.MethodsA longitudinal nationally representative survey was used for this study. We used five waves of China Family Panel Studies (CFPS) survey data. The final sample consisted of 145 843 observations. A two-way fixed-effects ordered logistic model was used for the analysis.ResultsThe results indicate that perceived good quality of care was positively associated with public satisfaction in health system regardless of rural–urban residence. Older adults and individuals with more than 3 years of college education were less likely to be satisfied with the system in rural areas. Personal income and the density of medical professionals in the geographic area tend to improve public satisfaction in rural areas. Having medical insurance coverage and fair or good self-rated health improved the probability of reporting public satisfaction in urban areas. Married people and individuals who lived in the West region were less likely to be satisfied with the health system in urban areas.ConclusionsKnowledge and skills of healthcare providers or physical quality of facilities are not sufficient in improving public satisfaction in the health system. Policymakers need to identify options to influence the important factors that affect public perception of the system. This analysis identified several policy-amenable factors to improve public perception of the health system in rural and urban China.

SİMÜLASYON TEMELLİ TIP EĞİTİMİN BÜTÇEYE SAĞLADIĞI KLİNİK VE EKONOMİK FAYDALAR

Especially in the last two decades, there has been an increase in simulation-based training applications to increase the technical and non-technical skills of health care providers. In many scientific studies, thereare many studies on the effect of simulation education and research applications on theincrease of cost and clinical skills. In this study, we conducted a literature study on the clinical and economic benefits of simulation-based medical education on the budget. In this context, in order to determine the clinical and economic benefits of simulation-based medical education to the budget, a search was carried out on Google Schoolar, Pupmed and Science directs earch engines between 2010-2020 by entering the words "Simulation-basedmedical education, cost-effectiveness, budget effect". By using the word groups specified at theend of all these operations; Pubmed 75 Google Schoolar 162 and ScienceDirect 37 reached 274 results in total. All there sults obtained were reviewed and studies not directly related to the subject and the same articles that are duplicate of each other were excluded; A total of 21 results in the form of reviews, research articles, papers and reports were evaluated. The scientific studies evaluated within thescope of this study support the fact that simulation-based training practices provide clinical and economic benefits to the budget and that there is a positive relation ship between them.

A comprehensive review of difficult airway management strategies for patient safety.

Difficult airway management is critical to ensuring patient safety. It involves addressing the challenges and failures that can occur, even with skilled healthcare providers, during face mask ventilation, intubation, supraglottic airway placement, invasive airway procedures, or extubation. Although the incidence of the most critical situation in airway management, "cannot intubate, cannot oxygenate," is low at 0.0019-0.04%, its occurrence can have severe consequences, including dental injury, airway injury, hypoxic brain damage, and even death. This study aimed to offer healthcare providers a comprehensive and evidence-based approach for difficult airway management by reviewing recent guidelines and incorporating the latest evidence-based practices to improve their preparedness and competence in difficult airway management, and thus ultimately contribute to improved patient safety.