Urban Health Care Research Articles

Factors contributing to differences in cervical cancer screening in rural and urban community health centers.

Community health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural-urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID-19 pandemic. Using 8-year pooled Uniform Data System (2014-2021) data and Oaxaca-Blinder decomposition, the extent to which CHC- and catchment area-level characteristics explained rural-urban differences in up-to-date cervical cancer screening was estimated. Up-to-date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014-2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural-urban difference in cervical cancer screening in 2014-2019 was mostly explained by differences in CHC-level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64years (9.8%), and catchment area-level's unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (-48.5%) or no insurance (-19.6%) counterbalanced the differences between rural-urban CHCs. The contribution of these factors to rural-urban differences in cervical cancer screening generally increased in 2020-2021. Rural-urban differences in cervical cancer screening were mostly explained by multiple CHC-level and catchment area-level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiencyin rural CHCs.

Reducing low-value interhospital transfers for mild traumatic brain injury.

The modified Brain Injury Guidelines (mBIG) were developed to stratify traumatic brain injuries (TBIs) and improve health care utilization by selectively requiring repeat imaging, intensive care unit admission, and neurosurgical (NSG) consultation. The goal of this study is to assess safety and potential resource savings associated with the application of mBIG on interhospital patient transfers for TBI. Adult patients with TBI transferred to our Level I trauma center from January 2017 to December 2022 meeting mBIG inclusion criteria were retrospectively stratified into mBIG1, mBIG2, and mBIG3 based on initial clinicoradiological factors. At the time, our institution routinely admitted patients with TBI and intracranial hemorrhage (ICH) to the intensive care unit and obtained a repeat head computed tomography with NSG consultation, independent of TBI severity or changes in neurological examination. The primary outcome was progression of ICH on repeat imaging and/or NSG intervention. Secondary outcomes included length of stay and financial charges. Subgroup analysis on isolated TBI without significant extracranial injury was performed. Over the 6-year study period, 289 patients were classified into mBIG1 (61; 21.1%), mBIG2 (69; 23.9%), and mBIG3 (159; 55.0%). Of mBIG1 patients, 2 (2.9%) had radiological progression to mBIG2 without clinical decline, and none required NSG intervention. Of mBIG2, 2 patients (3.3%) progressed to mBIG3, and both required NSG intervention. More than 35% of transferred patients had minor isolated TBI. For mBIG1 and mBIG2, the median hospitalization charges per patient were $152,296 and $149,550, respectively, and the median length of stay was 4 and 5 days, respectively, with the majority downgraded from the intensive care unit within 48 hours. Clinically significant progression of ICH occurred infrequently in 1.5% of patients with mBIG1 and mBIG2 injuries. More than 35% of interfacility transfers for minor isolated TBI meeting mBIG1 and 2 criteria are low value and may potentially be safely deferred in an urban health care setting. Therapeutic/Care Management; Level IV.

Psychometric Validation of the Persian Version of Multidimensional Health Locus of Control Scale (MHLC-C) for Menopausal Women

Background. The Health Locus of Control (HLC) serves as a mediator between an individual’s behaviors and health status, influenced by various cultural, environmental, and situational factors. Its measurement reflects health beliefs and attitudes, ultimately leading to healthy behaviors. Menopause is a significant phenomenon in women’s lives, often resulting in a wide range of symptoms and health issues. Therefore, the perception of HLC plays a crucial role in promoting healthy behaviors and managing menopausal symptoms. This study aimed to assess the validity and reliability of the Persian version of the short form Multidimensional Health Locus of Control Scale (MHLC) in Iranian menopausal women and explore its interrelationships. Methods. A cross-sectional study was conducted with 271 menopausal women from September to November 2023. Psychometric properties such as construct validity (confirmed through confirmatory factor analysis), convergent validity (evaluated using average variance extracted), and internal consistency (assessed by Cronbach’s alpha, composite reliability and rho_A factor) were examined. Discriminant validity was determined using the Fornell–Larcker criterion. Reliability was further established through Cronbach’s alpha and McDonald’s Omega coefficients. The predictive relevance of the model and associations between constructs were analyzed using various statistical measures. Data analysis was conducted using SPSS v.27 and Smart PLS 3.0 software. Limitations of this study include that it was conducted in urban health centers, only women with at least primary education were included, and reliance on self-reported data. Results. The initial stage of construct validity involved the Kolmogorov–Smirnov test, with confirmatory factor analysis demonstrating a good model fit. Significant correlations were found between internal health control and factors related to doctors and other people, indicating that internal health control directly influences these factors in managing menopausal symptoms and health problems. Cronbach’s alpha and McDonald’s Omega coefficients for the 13-item MHLC-C scale were satisfactory (0.81 and 0.72, respectively). Conclusions. The Persian version of the 13-item MHLC-C has been validated as a reliable tool for assessing the health locus of control in Iranian menopausal women. Internal health control was found to significantly impact perceptions related to doctors and other people, highlighting its importance in managing menopausal symptoms effectively.

Stratification of Urban Health Centers of Khorramabad Based on Socioeconomic Status of Households Using Factor Analysis and Cluster Analysis

Background: In numerous studies in the field of medical sciences, researchers use health centers as a frame for stratified sampling. Since socioeconomic variables play a major role in health outcomes, the present study aimed to classify urban health centers of Khorramabad in terms of the socioeconomic status of households using factor and cluster analysis. Materials and Methods: In this cross-sectional study, the statistical population included all urban areas of Khorramabad based on the population and housing census conducted by the Statistical Center of Iran. Firstly, the scatter maps of urban areas and health centers were adopted together. Thereafter, socioeconomic indexes of urban areas were calculated in seven fields, and exploratory factor analysis was used to reduce dimensions. Finally, the similar health centers in terms of factor scores were allocated to the same clusters by k-means cluster analysis using SPSS software (version 26) and were displayed on city maps using Arc GIS software. Results: Three factors identified in factor analysis explained about 73.3% of the total variance of socioeconomic indexes. Based on cluster analysis, 11 health centers were located in cluster 1 (related to lower educational attainment, poorer housing amenities, and higher rate of homelessness and divorce), 16 centers were located in cluster 2 (related to higher studying persons rate, lower marriage rate in women, lower unemployment rate, and higher residence in apartment flats) and 10 health centers were located in cluster 3 (related to higher academic graduates, more profitable jobs, and better housing amenities). Conclusion: The results of this research can be used in health studies in urban areas of Khorramabad as a basis for performing stratified sampling. Furthermore, it is recommended that authorities adopt more effective planning to improve deprived areas in cluster one.

Enhancing cardiological care in modern large cities: A case study of Almaty

Relevance. Cardiovascular diseases are prevalent across all population segments in large cities, necessitating effective strategies to enhance cardiological care. Purpose. This research aims to explore fundamental principles for advancing cardiological care in large cities, evaluating the potential integration of key trends over various timeframes. Methodology. Utilizing a systematic analysis approach, the study combines statistical investigations of cardiological care aspects, focusing on several polyclinics in Almaty to illustrate the broader trends and requirements. Results. The study found a significant increase in the number of cardiological procedures performed in Almaty, highlighting the growing demand for specialized cardiology services. High-tech equipment and well-trained personnel were identified as critical factors for improving diagnosis and treatment outcomes. Establishing specialized cardiology rooms significantly enhanced patient care, providing comprehensive services from diagnosis to emergency care. Conclusions. The findings suggest that focusing on high-tech equipment and professional training can substantially improve cardiological care quality in large cities. The establishment of specialized cardiology units is crucial for delivering comprehensive services, which are essential for managing the increasing workload in urban healthcare settings. These strategic improvements can significantly reduce cardiovascular mortality rates and enhance the overall effectiveness of cardiological care. Keywords: urban healthcare; medical technology; patient recovery; professional training; specialized cardiac services

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

Adverse events following Covaxin administration among adolescents (15-18 years) - A pharmacovigilance study in a district in Northern India.

The study was undertaken to observe the adverse event following immunization (AEFI) to the Covaxin vaccine in young adolescents in the age group of 15-18 years in a district in Northern India. The study was conducted to assess the safety profile of the COVAXIN vaccine. This was a prospective observational study conducted at rural and urban health centers of a district in Northern India. We included the beneficiaries of the COVAXIN between the age of 15 and 18 years. The administration of the COVAXIN occurred in our district from January 2022. Periodic visits were conducted to the urban and rural health centers of the city to record any suspected adverse drug reaction following immunization in the defined population. The study was conducted for a period of 1 year (January 2022 to December 2022). A total of 72,771 adolescents (15-18 years) received the first dose of Covaxin and 49,046 received the second dose. No adverse drug event following immunization was reported during the study. Thus, it can be concluded that Covaxin was found to be safe in adolescents (15-18 years).

Using Unannounced Standardized Patients to Assess Clinician Telehealth and Communication Skills at an Urban Student Health Center

PurposeAs the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. MethodsFrom April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. ResultsUSP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. DiscussionResults suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.

Cardiovascular Risk Profiling Using the Globorisk Calculator among Noncommunicable Disease Patients Attending Primary Health Centers of a Tertiary Care Teaching Hospital in South India: A Cross-Sectional Analytical Study.

Cardiovascular diseases (CVDs) account for over three-quarters of all deaths taking place in developing nations. The present study aims to stratify noncommunicable disease (NCD) patients using the Globorisk chart for predicting their 10-year risk of a major (fatal or nonfatal) CVD event and to estimate the level of agreement between this country-specific chart and the existing World Health Organization (WHO)/International Society of Hypertension (ISH) risk strata. A record-based cross-sectional analytical study was conducted in 2018 among adults attending the NCD clinic of one rural and one urban primary health center in Puducherry. Laboratory and office risk calculators of the Globorisk chart were used to calculate the risk. The median age (interquartile range (IQR)) of the 760 study participants was 58 (50-65) years. When calculated using the Globorisk prediction chart, 22.1% (n = 168) of the participants had a <10% risk for any CVD event in the next 10 years, whereas the same risk was found in 71.1% (n = 540) by using the WHO/ISH risk chart. There was no agreement found between the two risk charts (k = 0.0174; P-value = 0.26). The Globorisk chart was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts.

A Self-Supervised Human Activity Recognition Approach via Body Sensor Networks in Smart City

In smart cities, pervasive sensing and wearable computing techniques are increasingly being employed to monitor and recognize human activities through body sensor networks, which have been widely used in urban safety, healthcare, and manufacturing. However, most researchers regard human activity recognition (HAR) as a high-cost research task requiring a large amount of labeled data, which is often unrealistic in real-world applications. To address this problem, we propose a self-supervised learning framework for HAR (SS-HAR). SS-HAR initially takes the unlabeled data generated by data augmentation as the input of the network, mines the supervised information of the unlabeled data under the effect of self-supervised learning, and uses the obtained backbone network as a feature extractor to extract activity features for subsequent classification. After that, we use part of the labeled data as the training set and extract the activity features using the backbone network for training and fitting the classifier. Then we utilize the rest of the data to verify the feasibility and effectiveness of the proposed self-supervised learning method. We have conducted multiple experiments on three publicly available datasets and one self-collected basketball activity dataset SZU_HAD_Basketball. The experimental results show that the SS-HAR method is able to achieve higher classification accuracy and stability than supervised and semi-supervised methods. Specifically, on the UCI dataset, SS-HAR achieves better classification performance compared to other approaches which improve the classification accuracy by 1% over the supervised method and by 5%-6% over the semi-supervised method respectively.

Advancing Urban Healthcare Equity Analysis: Integrating Public Participation GIS with Fuzzy Best–Worst Decision-Making

This study provides an innovative collaborative spatial decision support system (SDSS) that aims to ensure an equitable spatial distribution of healthcare services. Evaluating the equality of access to health services across different geographical areas is important, as it requires the analysis of various criteria such as the proximity of health centres and hospitals (HCHs), the quality of services offered, connectivity to primary roads, the availability of public transportation hubs, and the density and distribution patterns of HCHs. This purpose is accomplished via the use of geographic information systems (GIS) and multi-criteria decision analysis (MCDA) methods. The proposed model includes the weights of the criteria, which are determined through the ordered weighted average (OWA) and evaluated based on their ORness, which ranges from 0 to 1. Furthermore, this model is improved by the best–worst fuzzy method (F-BWM). This approach produces a spatial map that clearly shows the equity of healthcare systems in urban environments. The findings show that the maximum score observed in this study was 0.38% (with an ORness value of 1), whilst the minimum score recorded was 0.28%. In the most severe scenario (ORness = 0), over 70% of the region shows different degrees of fairness, ranging from moderate to suitable and very suitable conditions. Governments and health authorities can use this information strategically to allocate resources and address inequities in access to healthcare facilities.

Physical Activity Intervention for Urban Black Women With Asthma: Protocol for a Randomized Controlled Efficacy Study.

Black women experience a higher prevalence of poor asthma outcomes and physical inactivity than their White counterparts. Black women comprise a particularly vulnerable group of patients with asthma, with some of the highest rates of asthma in adults, high health care use (emergency department visits and hospitalizations), and the highest crude asthma mortality rate of all race or ethnicity groups. Despite recommendations to engage in regular physical activity, fewer than 15% of Black women meet the 2008 National Physical Activity Guidelines, the lowest of all racial subgroups of adults. Given the connection between physical inactivity and poor asthma outcomes, addressing physical activity among Black women with asthma is imperative. This 2-arm randomized controlled trial aims to (1) determine the efficacy of a lifestyle walking intervention on asthma control compared to an education (control) group over 24 weeks, (2) examine the maintenance effects of the lifestyle walking intervention on asthma control at 48 weeks, (3) explore the behavioral mediators (eg, self-efficacy, social support, self-regulation, and daily physical activity levels) and contextual moderators (eg, baseline asthma severity, neighborhood environment, comorbid conditions, and social determinants of health) that contribute to treatment responsiveness, and (4) assess the reach and implementation potential of the intervention. The proposed study (ACTION [A Lifestyle Physical Activity Intervention for Minority Women with Asthma]) delivers a 24-week lifestyle walking intervention designed for and by urban Black women with asthma. Participants (n=224) will be recruited through 2 urban health care systems that care for a diverse Black population. Patients will be randomized to one of two groups: (1) ACTION intervention (group sessions, physical activity self-monitoring-Fitbit, and text-based support for step goal setting) or (2) education control (an individual asthma education session and SMS text messages related to asthma education). Outcome assessments will take place at baseline, 12, 24, and 48 weeks. The primary outcome is a change in asthma control from baseline to week 24 as assessed by the asthma control questionnaire-6 (ACQ-6). Secondary outcomes include asthma-related quality of life, health care use, and asthma exacerbations and behavioral outcomes such as self-efficacy, self-regulation, social support, and physical activity. This study was funded by the National Institute of Minority Health Disparities in August 2022. We pilot-tested our recruitment and intervention procedures and began recruitment in April 2023, with the enrollment of our first participant in May 2023. The anticipated completion of the study is April 2027. This study will deliver a new approach to physical activity interventions in Black women with asthma and help to provide guidance for addressing physical activity within this subgroup. This study will also provide a potential framework for future studies in minoritized populations with other disease conditions associated with low levels of physical activity. ClinicalTrials.gov NCT05726487; https://clinicaltrials.gov/study/NCT05726487. DERR1-10.2196/55700.

Systemic seismic risk assessment of urban healthcare system considering interdependencies to critical infrastructures

The performance of healthcare and other emergency systems, like firefighting, is of utmost importance in the aftermath of natural disasters such as seismic events. However, previous studies have often overlooked the interconnectedness of emergency systems to other critical infrastructures. In reality, the performance of the healthcare system does not only rely on the vulnerability of hospital buildings, but also on the vulnerability and performance of interdependent critical infrastructures, such as the transportation system for the accessibility of injured people to hospitals from the damaged sites or the continuous supply of water and electricity for the uninterrupted operation of hospital facilities. These interdependencies can significantly impact the overall emergency response effectiveness and is vital to consider them in the design and assessment of healthcare systems to safeguard resilience of the community. This study proposes a comprehensive methodological framework and associated metrics for evaluating and mapping the healthcare system's performance considering its interdependencies with other critical infrastructures. It encompasses hazard characterization, risk assessment at both component and system levels, and network-based analysis with conditional branching to account for first and second order interdependencies. The proposed framework is applied to the healthcare system of Thessaloniki, Greece. The operational tool and insights can help to prioritize ex-ante investments and identify ex-post intervention measures, ensuring an emergency response system on an urban scale within a resilient systemic perspective. Its applicability can be extended to address a spectrum of other hazards and interdependencies at urban and regional scales, to ensure peoples' safety and minimize socioeconomic losses.

Structure of Health Care System: Vital in Promoting Community Well-Being

It is understood on a comprehensive basis that individuals, belonging to all occupations, communities, and socio-economic backgrounds are overwhelmed by different types of health problems and illnesses. These are experienced in a major or minor form. The research studies have indicated that in rural communities, the individuals are depending on the natural environmental conditions in order to treat various types of health problems and illnesses. But there are formulation of programs, which are putting emphasis on bringing about improvements in health care services within rural communities. On the other hand, within urban communities, the medical and health care services are in a well-developed condition. The individuals employed in these are required to be well-versed in terms of job duties and responsibilities. Furthermore, the different types of methodologies and procedures are required to be put into operation in a satisfactory manner. As a consequence, individuals are rendering an important contribution in promoting good health, physically as well as psychologically. One of the important aspects that needs to be taken into account is, individuals are required to prepare themselves adequately in making sure, individuals are benefitting from the services. Therefore, it is well-understood, structure of health care system is vital in promoting community well-being. The main concepts that are taken into account in this research paper are, the health care system in rural areas, functioning of community health care centres, functioning of primary health care centres, functioning of sub-centres and measures to be implemented in bringing about improvements in structure of health care system.

Assessment of Urban Health Extension Package Utilization and Healthcare Seeking Behavior among Model and Non-Model Households in Addis Ababa, Ethiopia

BACKGROUND: Ethiopia has been implementing the Urban Health Extension Program (UHEP) at the community level since 2009. The program was a pro-poor and cost-effective approach that aimed to enhance utilization of urban health extension program packages and empower community healthcare-seeking behavior. This study was conducted to compare the utilization and healthcare-seeking behaviors of urban health extension program packages and the healthcare-seeking behaviors of model and non-model households. METHODS: A community-based comparative cross-sectional study was conducted among 594 female household heads (297 models and 297 non-models) using a structured face-to-face interview. A bivariate and multivariable logistic regression analysis was employed to identify associated factors. A p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval were carried out to identify significant factors. RESULTS: Urban health extension program package utilization was 78% among model households and 64.2% among non-model female households. A total of 75.5% model and 65.2% non-model female household heads had appropriate healthcare-seeking behavior. Moreover, having information about UHEPs (AOR = 2.35, 95% CI = 1.08-3.42), frequency of home visits by UHEWs (AOR = 2.12, 95% CI = 1.01-3.13), knowledge about UHEPs (AOR = 3.14, 95% CI = 2.43-4.47), and household graduation status (AOR = 3.052, 95% CI = 2.024-5.13) were significantly associated with urban health extension program package utilization and healthcare-seeking behaviors. CONCLUSION: In terms of utilization, the overall urban health extension package favors model female household heads over non-model female household heads. As a result, raising awareness, having frequent home visits, and focusing more on disease prevention and control packages will boost the adoption of urban health extension packages.

The effect of educational intervention on efficacy of 1% permethrin shampoo and 4% dimeticone lotion to treat head lice infestation using propensity score matching (PSM)

BackgroundHead lice are a main public health problem and the most important human ectoparasites and the use of pediculicides is the most common way to control it. One of the possible causes of treatment failure is the lack of improper application of pediculicide. The aim of this study was to assess the effect of education on efficacy of 1% permethrin or 4% dimeticone lotion to treat head lice infestation.MethodsThis quasi-experimental study included 100 individuals with head lice infestation from comprehensive urban health centers in Ardabil as the intervention group, and 400 individuals from East Azerbaijan and West Azerbaijan provinces as the control group, from April to March 2019. The data collection tools included a demographic questionnaire and an examination recording sheet, which documented the presence of adult lice or nits. Due to the inability to perform random assignment and control for numerous observed covariates, propensity score matching (PSM) was used.ResultsThe outcome of treatment included elimination of head lice infestation on is 7, and in the case of recurrence, it was considered on days 14 and 30 after treatment. The results showed that the educational intervention program had a significant positive effect on the efficacy of both treatments. The likelihood of improvement was approximately three times greater in the intervention group compared to the control group.ConclusionParticipants who received the training intervention (OR = 3.29; CI 95%: 2.21–4.88) were more likely to have a successful treatment than control group. In the case of providing proper training on the use of pediculicides and observing hygiene tips to patients with pediculosis, could help to successful treatment of pediculosis.

Seasonal variations in respiratory morbidity in primary care and its correlation with the quality of air in urban Odisha, India.

Poor air quality, especially in urban regions among low-and middle-income countries such as India poses a significant healthcare challenge. Amongst urban areas, metropolitan cities garner the utmost importance for air quality related policies and studies with limited studies from tier II cities which are thought to be relatively immune to air pollution. Hence, we aimed to identify the most frequent respiratory morbidities and explore its correlation with exposure to ambient PM2.5 particles in Bhubaneswar (a tier II city in coastal India), Odisha. A chart review was carried out through data extracted from the records of urban health centres. Data on PM2.5 concentrations were obtained from Odisha State Pollution Control Board. The morbidities were coded by using the International Classification of Primary Care‑2 system (ICPC-2). Descriptive statistics such as incidence of respiratory illnesses was computed across seasons. The ecological correlation between respiratory morbidity patterns and corresponding concentration of PM2.5 in air was analysed for each season. A positive correlation (r = o.94) between PM2.5 and respiratory morbidities was observed. The incidence of respiratory morbidities was 183.31 per 1000 person year. We identified 21 out of 43 respiratory diseases classified under ICPC-2. Upper Respiratory Tract Infection was the most commonly (116.8 per 1000 person year) incident condition. We observed one-fourth increase in the incidence of respiratory illnesses during winters. Respiratory morbidities are common in urban Bhubaneswar which follows a seasonal pattern and are possibly linked with the seasonal variations in levels of PM2.5 particles. Our study highlights that tier II cities are equally prone to health effects of air pollution. Future programmes and policies should take these cities into consideration too.

Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh.

Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.

A Study to Assess the Knowledge on Modifiable Risk Factors for Non-communicable Diseases among Adults Attending Out Patient Department of Selected Urban Health Centre

Non communicable diseases (NCDs) are the leading global causes of death, causing more deaths than all others cause combined, and they strike hardest at the world's low- and middle-income populations. The study aim was to assess the knowledge on modifiable risk factors for non-communicable diseases among adults in selected urban community, Navsari. and develop an information booklet regarding non communicable diseases. Non-experimental, descriptive research design was adopted to collect the data. Simple random sampling technique was used with the sample size of 300. Modifiable risk factors for non-communicable diseases were assessed by using checklist as risk assessment Performa including to self-structured method for knowledge questionnaire to know the level of knowledge regarding modifiable risk factor for non-communicable disease. Out of 300 sample 35.33% of adults had inadequate knowledge, 61.33% of the adults had moderate knowledge and only 3.33% adults were having adequate knowledge regarding modifiable risk factors for non-communicable diseases among adults. Conclusion: Critical prevalence of risk factors for non-communicable diseases among adults with poor knowledge on modifiable risk factors for non-communicable diseases.

The Burden of Cardiovascular Disease from Air Pollution in Rwanda.

Rwanda, like many countries in sub-Saharan Africa, is still relatively early in development. Industrialization and urbanization are major drivers of the county's economic growth. Rwanda is also undergoing an epidemiological transition, from a pattern of morbidity and mortality dominated by infectious diseases to a pattern shaped by non-communicable diseases (NCDs). The rise in NCDs is due, in part, to increasing exposures to environmental hazards. These include emissions from the growing number of motor vehicles and toxic occupational exposures. Cardiovascular disease (CVD) is now an increasingly important cause of death in Rwanda, and ambient air pollution is a CVD risk factor of growing importance. To quantify the burden of CVD attributable to air pollution in Rwanda and identify opportunities for prevention and control of air pollution and pollution-related disease. We relied on the 2019 Global Burden of Disease (GBD) study for information on levels, sources, and trends in household and ambient air pollution and the burden of pollution-related disease in Rwanda. Information on pollution sources was obtained from the Health Effects Institute State of Global Air 2019 report. An estimated 3,477 deaths (95% Uncertainty Interval [UI]: 2,500-4,600) in Rwanda in 2019 were attributable to air pollution-related CVD. Of these, 689 (UI: 283-1,300) deaths were from ambient air pollution-related CVD, while 2,788 (UI: 1,800-3,800) deaths were from household air pollution-related CVD. Rwanda is experiencing increased rates of disease and premature death from NCDs, including CVD, as the country grows economically. While household air pollution is still the top pollution-related cause of disease and premature death, rising levels of ambient air pollution are an increasingly important CVD risk factor. Actions taken now to curb rising levels of ambient air pollution will improve health, reduce CVD, increase longevity, and produce great economic benefit for Rwanda. The single most effective intervention against air pollution will be a rapid nationwide transition to renewable energy. We recommend additionally that Rwanda prioritize air pollution prevention and control, establish a robust, nationwide air monitoring network, support research on the health effects of air pollutants, and build national research capacity. The allocation of increased resources for rural and urban public health and health care will complement air pollution control measures and further reduce CVD. To incentivize a rapid transition to renewable energy in Rwanda and other nations, we recommend the creation of a new Global Green Development Fund.