Type Of Health Facility Research Articles

Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey

BackgroundNon-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya.MethodsA cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services.ResultsOf the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide.ConclusionsImportant gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

Preeclampsia and eclampsia: Its burden and distribution across facilities in Ethiopia.

This study aimed to analyse national health facility burden of preeclampsia/eclampsia and its regional distribution in Ethiopia. This evidence is an important aspect to work towards reducing maternal and newborn complications. This study uses data from the 2016 Emergency Obstetrics and Newborn Care (EmONC) survey which national census of public and private health facilities that provided delivery services. Cross-tabulation of variables was conducted based on region, location, types of health facility, and the management authority of health facilities. Spatial analysis was conducted to investigate spatial regional distribution of preeclampsia/eclampsia. A total of 3804 health facilities were included in the survey. Nationally, preeclampsia/eclampsia contributes to 5.9% of all maternal complications and 10.5% of maternal deaths. While 82% of total deliveries were reported from health centres, hospitals and specialised centres reported nearly 10 times more cases of PE/E (23 per 1000 deliveries) than health centres (2.4 per l000 deliveries). The highest number of preeclampsia/eclampsia cases were reported in Addis Ababa and the Harari region where there were 32 and 24 cases per 1000 deliveries, respectively. A substantial proportion of direct obstetrics complications due to preeclampsia/eclampsia were reported from Afar, Somali, Harari and the Benishangul Gumuz regions (19.9%, 18.0%, 12.8%. 11.5%, respectively). Preeclampsia/eclampsia contributed to a high proportion of maternal complications and death. Disproportionally, the highest burden of preeclampsia/eclampsia was reported in developing regions of Ethiopia. These region's health facilities'effort on case detection, reporting and evidence generation should be strengthened to inform policy especially those located in rural location.

Health Professionals' Knowledge, Attitude and Practices Regarding COVID-19 in Dessie City, Northeast Ethiopia: A Facility-Based Cross-Sectional Study.

BackgroundKnowledge and attitudes are among the key drivers of social behavioral change. We assessed employed health professionals' (HPs) knowledge, attitude, and practice regarding COVID-19 in Dessie city, northeast Ethiopia.MethodsA facility-based cross-sectional study was conducted among 419 HPs working at Dessie city from 17 to 21 May 2020. The data were collected using a self-administered structured questionnaire. Knowledge, attitude, and practice are measured using 19, 16, and 8 questions, respectively. Knowledge and attitude scores are dichotomized at the 3rd quartile, while practice is using the mean value. Data entry and analysis were conducted using EpiData Manager 4.2 and SPSS 25, respectively. Three independent logistic regression analyses were carried out to determine the associated factors. We defined significant association at a p-value of < 0.05.ResultsOut of 419 participants, 369 (88.1%) have sufficient knowledge regarding COVID-19 (95% CI: 85–91). The mean knowledge score is 16.8 with a ± 2.1 SD. Similarly, 355 (84.7%) of the HPs have a favorable attitude toward COVID-19 (95% CI: 81–87.9). The mean attitude score is 14 with ± 2.1 SD. However, practice regarding COVID-19 is adequate only in 69.7% (292) of the HPs (95% CI: 65.2–94). The mean practice score is 5.1 with a ± 1.3 SD. Sufficient knowledge is significantly associated with the type of health facility (AOR: 4.4, 95% CI: 1.4–13.3), degree and above education (AOR: 2.6, 95% Cl: 1.4–4.9), radio availability (AOR: 2.4, 95% CI: 1.3–4.7), and social media utilization (AOR: 2.3, 95% CI: 1.1–5.1). The predictors of favorable attitude are training (AOR: 3.1, 95% CI: 1.6–6.1), sufficient knowledge (AOR: 5.2, 95% Cl: 2.6–10.4), and type of health facility (AOR: 2.3, 95% CI: 1.1–5.2).ConclusionMost HPs have sufficient knowledge and a favorable attitude regarding COVID-19. However, practice is relatively low and there remains plenty to build assertive preventive behaviors. The gap between knowledge and practice should be narrowed through an appropriate social and behavioral change communication strategy.

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

BackgroundAccess to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.MethodsData for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.ResultsThe mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.ConclusionsPrivate facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis

BackgroundCommunity-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women...

Exploring Enablers and Barriers to Utilize Printed Information, Education, and Communication Materials Among Healthcare Providers of North Shoa Zone, Oromia, Ethiopia

BackgroundInformation, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020.MethodsA descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings.ResultsThe findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider’s related factors, and government-related factors.ConclusionIn this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.

Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database.

This study examined whether the association of socioeconomic status (SES) and non-small cell lung cancer (NSCLC) stage varied by race/ethnicity and health care access measures. This study used data from the 2004-2016 National Cancer Database for patients aged 18-89 years who had been diagnosed with Stage 0-IV NSCLC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for the associations of area-level SES with an advanced stage at diagnosis via multilevel, multivariable logistic regression. The stage at diagnosis was dichotomized into early (0-II) and advanced (III-IV) stages, and area-level SES was categorized on the basis of the patient's zip code level: (1) the proportion of adults aged ≥25 years without a high school degree and (2) the median household income. The models were stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander), insurance status (none, government, and private), and health care facility type (community, comprehensive community, academic/research, and integrated network). The study population included 1,329,972 patients. Although only 17% of the NH White patients were in the lowest income quartile, 50% of the NH Black patients were in this group. Lower area-level education and income were associated with higher odds of an advanced-stage diagnosis (aOR for education, 1.12; 95% CI, 1.10-1.13; aOR for income, 1.13; 95% CI, 1.11-1.14). These associations persisted among NH White, NH Black, Hispanic, and Asian patients; among those with government and private insurance (but not the uninsured); and among those treated at each facility type. Area-level income and education are strongly associated with an advanced NSCLC diagnosis regardless of the facility type and among those with government and private insurance.

Empirical study of consumer behaviour in health insurance sector

This article devoted to the analysis of consumption of services held under Health Insurance, which pertains to utilization of health services. Health utilization behaviour of the sampled households was observed by obtaining information on different health variables like monthly health expenditure, health risk, health status, types of morbidity and hospitalization. It also encompasses information about choice of treatment and choice of type of health facility -public/private. A comparison of insured and uninsured households was made in the study so as to comprehend the difference in their health utilization behaviour. An earnest effort has been made to examine the level of satisfaction regarding Health Insurance policy among the insured household and also focused on the two major issues of Health Insurance sector related to the presence of information asymmetries viz Adverse Selection and Moral Hazard. Due to better private information about their health status, the insured may have a positive association between health risk and purchase of Health Insurance (Adverse Selection). Besides, the consumers might have a tendency to over utilize the health services because they are available at lower cost due to purchase of Health Insurance (Moral Hazard). Presence of both these problems is empirically tested in this paper.

Feasibility, acceptability, and appropriateness of a mobile health stroke intervention among Ghanaian health workers

BackgroundmHealth interventions can improve care delivery in settings with limited resources. The Phone-based Interventions under Nurse Guidance after Stroke (PINGS) is a nurse-led, mHealth-centered approach to blood pressure (BP) control among recent stroke survivors with hypertension in Ghana. It has 4 key components: (1) home blood pressure monitoring, (2) nurse-coordinated mhealth consults, (3) phone alerts as medication reminders, and (4) patient motivational messages delivered as interactive voice recordings. ObjectiveTo assess the feasibility, acceptability, and appropriateness for scale up of the PINGS intervention in Ghana, from the perspective of health workers. MethodsBetween July and August 2021, we deployed an online questionnaire describing the components of PINGS to a cross-section of health workers in Ghana. The questionnaire used an adaptation of psychometrically validated Likert scale measures to elicit agreement or disagreement with attributes of the intervention. The questionnaire was distributed online to approximately 4000 healthcare workers via email and social media platforms. A summary of descriptive statistics was obtained; summed composite scores were then calculated, dichotomized, and binary logistic regression performed using R programming software. ResultsOf 653 health workers who completed the survey, 57.2% were male; 73.2% clinicians; median age was 33 years (IQR 29, 37). Respondents' primary workplaces were public (64.4%), quasi-government (9.4%), and private, including mission-based (26.2%) facilities. PINGS was deemed feasible, acceptable, and appropriate by 93.9%, 94.8%, and 95.1% of respondents respectively. Clinical staff had higher odds of finding PINGS feasible (OR 4.10; C.I. 2.15, 8.0; p < 0.001), acceptable (OR 3.76, C.I. 1.87, 7.69; p < 0.001), or appropriate (OR 2.91, C.I. 1.41, 5.95; p = 0.004) compared to non-clinical staff. There was no statistically significant difference in the rating of each measure when analyzed by age, sex, years of health work experience, geographic location, type, or level of health facility. ConclusionAn overwhelming majority of health workers (particularly clinical staff) considered PINGS to be a feasible, acceptable, and appropriate for BP control among stroke survivors in Ghana.

Comparative assessment of structures and treatment processes in public and private hiv treatment centres in port harcourt, rivers state

Background: HIV treatment centres use the WHO standard policies and guidelines to conduct HIV testing services, and anti-retroviral treatment to people living with HIV. The purpose of the study was to assess and compare structures and treatment processes in public and private HIV treatment centres in Port Harcourt, Rivers State.&#x0D; Materials and Methods: This was a comparative cross-sectional study carried out in both public and private HIV treatment centres in Port Harcourt, Rivers State. The sample size of 10 public and 10 private HIV treatment centres were used for this study. A stratified sampling method was used to randomly select ten public and ten private HIV treatment centres from existing forty-six (46) public and forty (40) private ART facilities in Port Harcourt metropolis, Rivers State. Public and private HIV treatment centres included in the study were all that had existed for 6 months, still functional and render HIV treatment to a minimum of 5 patients per week. Other treatment facilities that did not meet this criteria were excluded. The study tool was pretested in other HIV treatment centres that were not selected for the main study. The tool was validated by performing Cronbach’s alpha (α) using 24 items tool for measuring the structure and 10 items tool for measuring the process; hence 0.902 and 0.736 were obtained for structure and treatment process respectively. A semi-structured interviewer checklist was used to assess structures of the treatment centres and evaluate the treatment process. The assessment the structure and evaluation of HIV treatment process was completed in a period of eight (8) weeks. Data was entered into the Statistical Package for Social Sciences (SPSS) software version 21 in numeric codes and analyzed using SPSS version 21. Comparative analysis for public and private HIV treatment centres were done. Ethical clearance for the study was obtained from the Research and Ethics Committee of the University of Port-Harcourt. Written permission from Rivers State Primary Health Management Board, Department of Planning, Research and Statistics (DPRS) and Rivers state Ministry of Health was obtained to cover the various health facilities used. Verbal permission/ consent were obtained from the directors of the private treatment centres.&#x0D; Result: A total of 20 facility assessment checklists were used to assess the public and private HIV treatment centres. The result indicated that public versus private structures of facilities had median scores of 11 versus 6.5 for utilities, 30.5 versus 22.5 for equipment, 24 versus 18.5 for commodities and the overall structural score of 65 versus 46. There was a statistically significant difference between the various structural domains and the health facility type: Utilities (5.60; p=0.02); Equipment (10.08; p=0.002); Commodities (6.27; p=0.01); Overall Structural scores (7.02; p=0.01). Also, (public versus private facilities) had median scores of (39 versus 34.5) with interquartile range of 39-46 for public facilities and (30-37) for private facilities. A statistically significant association was observed between HIV treatment process in public and private facilities (10.87; p=0.001).The HIV treatment process in public versus private facilities had median scores of (39 versus 34.5) with interquartile range of 39-46 for public facilities and (30-37) for private facilities.&#x0D; Conclusion: Based on findings in this study, the researchers conclude that the public HIV treatment centres had good structures in offering HIV service delivery. The public HIV treatment centers had a better HIV treatment process than the private HIV treatment centres. The non-governmental organizations should be encouraged to take responsibility of equipping private facilities with the needed structure which in turn will enhance HIV treatment process.

Performance evaluation in healthcare buildings: a systematic literature review

Abstract Healthcare buildings are complex as their occupants may have different health conditions. In this context, building performance evaluations can help to achieve better performance perceived by occupants. Thus, this paper has developed a systematic literature review (SLR) on performance evaluation in healthcare buildings to understand their intrinsic characteristics, in addition to developing an overview of the subject. The objective was to identify the purpose of the evaluations, the criteria evaluated, the evaluation methods, the type of healthcare facilities evaluated, as well as the temporal and spatial distribution of papers. The research was conducted using three electronic databases, and eighty-three papers were examined according to the 5W1H tool. As a result, the buildings assessed covered health services at all stages of life, physical and mental issues. Six groups of criteria were identified, highlighting: spatial, lighting, acoustic comfort, energy issues, and the materials and finishes used. Moreover, relationships were established between the types of buildings, evaluated criteria, and tools used. Finally, the SLR collaborated with the understanding of performance in healthcare buildings, identified that these buildings are being evaluated, contributing to the health, well-being, and satisfaction of occupants as buildings that perform better tend to be better places of healing and work.

Costing of services under National Tuberculosis Elimination Program at public health facilities of northern India

BackgroundCosting of resources helps to measure financial implications and effective utilization of resources of national programs. As there is limited evidence about cost per service, current study was done to assess the cost of services under National Tuberculosis Elimination Program (NTEP) at Community Health Centres (CHCs) and Primary Health Centres (PHCs) of northern state of India. Material and methodsCross-sectional study carried out in two districts and from each district eight CHCs and PHCs were randomly selected. ResultsMean annual cost of providing NTEP services at CHCs and PHCs were US$5243.1 (95%CI: 3008.0–7225.4) and US$1031.9 (95%CI: 669.1–1447.1) respectively. Across both centres human resource contributes to the most (CHC: 72.9%; PHC: 85.9%). One way sensitivity analysis was carried out for all health facilities and observed that human resource cost influences most cost per treated case by providing services under NTEP. Although relatively very less but cost of drugs also influences cost per treatment. ConclusionCost of delivering services was high for CHCs as compared to PHCs. At both types of health facilities, human resource contributes the most to cost of delivering services under the program.

Geospatial Distribution of Health Centers in Dass Local Government Area of Bauchi State, Using Geographic Information System (GIS) Tools

This paper examined the spatial distribution of health care facilities in Dass local government area of Bauchi state using GIS tools. Data were obtained from primary and secondary sources: a GPS was used to collect the coordinates of each health care facility. Data from the Ministry of Health (Bauchi State) about the location, name and types of health care facilities in the study area included one general hospital; one model primary health centre, fourteen primary health centers, one clinic, one dispensary and one health post. Population data was obtained from the National Population Commission (NPC, 2006). GIS analysis was used in analyzing the data. The analysis of nearest neighbour was done by using the extension of Arc GIS 10.5 in the spatial analyst tool and average nearest neighbour. The result shows that there is less than 1% (0.01 level of significance) likelihood that the spatial pattern of the distribution of health care facilities in Dass Local Government Area is dispersed and this could be as a result of random chance. This might be as the result of the fewer number of health facilities. The research recommends that government should locate health care services close to the people as possible as distance was found to influence utilization.

Are cesarean deliveries equitable in India: assessment using benefit incidence analysis

BackgroundIn the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India.DataData from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis.ResultsA strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066).ConclusionThe utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India.

From theory to practice: Association between community health workers' home visit and neonatal morbidity in a rural area of North India

BackgroundAverting the hospital admissions for morbidity by timely providing home-based care or referral in case of neonatal illness is important outcome of home visits by Accredited social health activists (ASHA) in India. ObjectiveTo determine the association between number of home visits by ASHA and identification of neonatal morbidity in 28 days of life in a north Indian Village. MethodsIt was a cross sectional survey including live births between August 2020 and January 2021 from a village in North India as study population. Taking estimated live births of the area the minimum study sample included was 120 to be covered in 2 months duration. ResultsAmong the 121 infants included in study the informants reported that 95% ASHA visited the home during neonatal period with 56.5% visits 4–6 times to single neonate. Any type of illness during neonatal period was reported by 21.5% informants. 69.2% (18/26) were visited by ASHA during the illness of neonate. 61.1% were referred by ASHA to nearest primary health center (11/18). 15.3% (4/26) underwent hospitalization for their illness and were cured. ASHA visiting a neonate 7–10 times in a month had 68% higher chances of identifying the signs of illness in the neonate (Adj OR (95% CI): 1.68 (0.12–23.26)). ConclusionThe community-based care by ASHA does reduce the risk of mortality however community has the right to choose the type of health facility and care for their newborns.

MIDWIFERY CARE OF DELIVERY WITH CHRONIC HYPERTENSION SUPERIMPOSED PREECLAMPSIA AND UTERINE MYOMA (CERVICAL)

Background: the most common causes of maternal death in Indonesia are hypertension/pre-eclampsia/eclampsia, bleeding, and infection. Hypertension in pregnancy ranks first as the cause of death in Indonesia at 33% (SRS Litbangkes, 2016). Cervical fibroids can cause complications in both pregnancy and childbirth. The purpose of this case report is to study midwifery care in complex cases. Case report: A 41-year-old woman, second pregnant, 36-37 week’s gestation, primipaternity, secondary primitua with chronic hypertension and uterine myoma (cervical) was referred to the hospital for delivery. Management focuses on support for the mother, involving the family, fulfill the needs of the mother, collaboration with the doctor conducting informed consent regarding the diagnosis, providing counseling and health education on tubectomy contraception, and accompanying the mother until the time of surgery. The mother's response is good, and optimistic about her condition and the baby. Conclusion: midwives in providing midwifery care in cases of delivery with chronic hypertension, superimposed preeclampsia and uterine myoma at an advanced health facility (Type A Hospital). Midwifery care is provided both independently and in collaboration with other professions. Delivery was carried out by caesarean section in accordance with the indications with the output of the mother and baby being healthy. Early detection, recognition of signs and symptoms, diagnosis, referral process and comprehensive management are carried out appropriately.

Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views.

Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views.

Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018.

Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.

The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019

BackgroundIndonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes.MethodsA cross-sectional study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured.ResultsOver the study period (2017–2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017–2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (P < 0.001). Bacteriologically positive TB patients were more likely to be tested for DM (OR = 1.37, 95% CIs 1.17,1.60). Patients diagnosed in sub-district level healthcare centers had a higher likelihood of being tested for DM than those in government and private hospitals (P < 0.05). Receiving DM treatment was associated with a higher likelihood of completing TB treatment/being cured (OR = 1.82, 95% CIs 1.20, 2.77).ConclusionsTB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.

Nationwide rates of outpatient clinic attendance by stroke survivors in Ghana: Analysis by region and facility

BackgroundData on utilization of outpatient departments (OPD) within a country is one strategic approach to gain nationwide and regional insights into the frequency of and types of health facilities where patients seek healthcare. In particular, such data could be used to develop quality improvement interventions in sub-Saharan Africa where the burden of stroke is high but outcomes are relatively poor. PurposeTo evaluate the characteristics of out-patient clinic visits by stroke survivors in Ghana by geo-ecological region (state) and by type of health facilities. MethodsWe conducted a retrospective analysis of prospectively collected data from 2019 to 2021 via the District Health Information System (DHIMS2) platform of the Ghana Health Service. Rates of stroke OPD encounters were expressed as number of visits by stroke survivors divided by number of OPD visits in a healthcare facility per 100,000 visits. ResultsAcross, 9309 health facilities, there were 23,074 stroke OPD encounters in 2019, 19,485 in 2020 and 20,333 in 2021. Rates of stroke OPD visits were 109.2/100,000 visits population in 2019, 96.5/100,000 visits in 2020 and 99.7/100,000 visits in 2021. The highest rates of stroke OPD visits occurred in the middle-belt regions over the study period perhaps reflecting the distribution of the national stroke burden. Nearly 75% of all stroke OPD visits occurred at a primary level, 17% at secondary- level, and 8% at tertiary-level health facilities. ConclusionThe middle geo-ecological belt has the highest rate of stroke OPD attendance in Ghana with nearly 3 out of 4 stroke patients seeking healthcare at a primary health care (PHC) facility. There is therefore a need to build human and infrastructural capacity at the lower cadres of healthcare delivery to optimally address stroke care delivery in these settings.