Visited Health Facilities Research Articles

Family planning communication through mass media and health workers for promoting maternal health care utilization in Nigeria.

Studies have demonstrated that health communication programmes, through community health workers or mass media, are a key strategy to promote awareness and uptake of essential maternal health services. This study investigated whether or not family planning communication through mass media and health workers has any association with maternal health care utilization uptake in Nigeria. Cross-sectional data were extracted from the 2003-13 Nigeria Demographic and Health Surveys. The study sample comprised 41,938 women aged 15-49 years who had a live birth during the 5 years preceding the survey. Outcome variables were adequacy of antenatal care visits and place of delivery. Receiving family planning messages from the radio, TV, newspapers, a family planning worker or during a health facility visit were considered as possible sources of exposure to family planning information. Radio (32.6%) was the most commonly reported source of family planning information, followed by TV (17.5%) and newspapers (6.1%). Less than one-tenth of respondents were visited by family planning workers (9.5%) and about one-third visited a health facility during the previous 12 months (30.3%). Those who reported receiving family planning information from the three types of mass media and who had contact with a family planning worker and/or health facility were more likely to have at least eight antenatal care contacts (odds ratio for TV use=1.172, 95% CI=1.058-1.297) and deliver at a health facility (odds ratio for TV use=1.544, 95% CI=1.350-1.766). These findings indicate that family planning communication through mass media and health workers could potentially improve the utilization of antenatal and health facility delivery services in Nigeria.

Migrants’ perceptions of health system responsiveness and satisfaction with health workers in a South African Province

ABSTRACT Background: There is global emphasis on quality universal health coverage (UHC) that is responsive to the needs of vulnerable communities, such as migrants. Objective: Examine the perceptions of migrants on health system responsiveness (HSR) and their satisfaction with health workers in public health facilities of a South African Province. Method: We conducted a cross-sectional study in 13 public health facilities. Following informed consent, we used a semi-structured questionnaire to collect sociodemographic information, patient perceptions of HSR and their satisfaction with health workers. Two open-ended questions gave patients the opportunity to comment on the health facility visit. We applied descriptive and multivariate analyses to our data, and thematic analysis to the qualitative responses. Results: A total of 251 migrant patients participated in the study, giving a response rate of 80.7%. The majority of patients were female (81.1%), and the mean age was 31.4 years. 30.0% of patients reported that they waited too long; 94.3% that the consulting nurse or doctor listened to them; and 89.4% that they received information about their condition. However, 81.7% said they did not know the name of the consulting nurse or doctor. The mean scores on patients’ satisfaction with health workers ranged from 7.0 (95% CI 6.42–7.63) for clerks, 7.7 (95% CI 7.4–8.0) for security guards, 7.4 (95% CI 7.1–7.6) for nurses and 8.3 (95% CI 7.93–8.63) for doctors. The predictors of patient satisfaction with nurses were being given information about their condition; polite treatment, time spent in facility, whether they received prescribed medicines; and stating that they would refer the health facility to family/friends. Four overlapping themes emerged: health workers’ attitudes; time waited at the health facility, communication difficulties; and sub-optimal procedures in the health facility. Conclusion: UHC policies should incorporate migrant patients’ perceptions of HSR and the determinants of their satisfaction with health workers.

A Study to Assess Contributing Factors of Teenage Pregnancy in Sunsari District of Nepal

Background: Early child bearing is a widely observed phenomenon in Nepal. However, little information is available in regard to its contributing factors. Teenage pregnancy is major contributing factor of maternal and child health and a challenging issue of public in developed and developing countries. This study explores the contributing factors of teenage pregnancy and knowledge about its consequences. Methodology: A descriptive study was conducted to find out contributing factors of teenage pregnancy among 102 pregnant teenagers at selected health facilities of Sunsari district. Pregnant teenagers visiting health facilities for antenatal check-up during study period were interviewed using pre-designed questionnaire. Data was managed using SPSS software. Descriptive statistics and chi square test were used. Result: The mean age of teenage pregnancy was 18±1.04 years and age at marriage 16.69±1.09 years. Majority were Muslim, 86.3% were homemaker, 31.4% had positive history of teenage pregnancy in family either-side, 38.2% had married at an age of 17 years, 31.4% were pregnant with their first child. Inadequate knowledge about teenage pregnancy, cultural acceptance, illiteracy, lack of knowledge on consequence of teenage pregnancy, difficulty to get information and access on family planning methods were major contributing factors and school dropout was reported as consequences of teenage pregnancy. Ethnicity, religion and education were associated with knowledge of teenage pregnancy. Conclusion: Knowledge about the risk and drawbacks of early marriage and early pregnancy should be increased not only among teenage girls but also to their parents and in-laws to change the attitude and practice of early marriage and teenage pregnancy.

Factors associated with the choice of primary treatment at the community level among the middle-aged and elderly in China.

As China is still in the process of establishing the hierarchical medical system, people have full autonomy in choosing medical institutions when they need to see a doctor. The basic working of a hierarchical medical system involves four parts: primary treatment at the community level, two-way referral, a partition of emergency and chronic disease, and a joint effort among different healthcare facilities. This study examines factors associated with primary healthcare use in a middle-aged and elderly Chinese population. Our study is a cross-sectional and observational survey involving 1659 adults aged 45 and above. The data are from the 2015 China Health and Retirement Longitudinal Study. According to the Andersen behavioral model, we used logistic regression to analyze the influencing factors of healthcare services utilization, including predisposing, enabling, and need factors. We also compared the relative importance of factors to healthcare services utilization by analysis of variance. During the recently 1-month period, 63.89% of the sample had their last visit to a primary healthcare facility. In the final logistic model, there were three predisposing characteristics (education level, children number, and work status), three enabling factors (household status, out-of-pocket expenses, and travel time to the healthcare facilities), and one need factor (three specific chronic diseases) were significantly associated with primary healthcare use. Having received more education, taking more travel time to the healthcare facility, paying more out-of-pocket expenses, and having heart problems were associated with a lower probability of choosing the primary healthcare facility. However, having more children, being still at work, with agricultural household status, diabetes, and arthritis were associated with a higher likelihood of having primary healthcare facility visits. Among all the factors, the three most powerful determinants were out-of-pocket expenses, travel time to the healthcare facility, and education. Policymakers need to consider these factors when improving the system of primary treatment at the community level, including improving reimbursement policy to distinguish the payment standard between hospitals and primary healthcare facilities.

KNOWLEDGE AND ATTITUDE TOWARDS HEPATITIS B INFECTION AMONG ADULTS IN TAMALE IN THE NORTHERN REGION OF GHANA

The study aims to investigate knowledge and attitude towards hepatitis B infection among adults in Tamale, Ghana. A cross sectional study was conducted using self-administered structured questionnaire to assess participants’ level of knowledge and attitude towards hepatitis B infection among adults in Tamale, Ghana. Data was collected from people who agreed to participate in the study. The study sample was 281 participants. Simple random sampling was used to recruit participants. Data was analysed using SPSS version 24 and study findings presented using text and tables. The study revealed that about half of the respondents had good knowledge on hepatitis B infection. There were even some knowledge gaps among the respondents who had good knowledge on the infection. The study also revealed that 63% of the respondents had good attitude towards hepatitis B vaccination. Those who did not vaccinate against hepatitis B indicated the cost and other reasons as the barrier for not vaccinating. Almost all the respondents indicated they will visit health facility for treatment in case they realise they are infected with hepatitis B. The study shows knowledge and attitude towards hepatitis B is not adequate. There is therefore the need to put in more measures to educate the public on hepatitis B in order to improve the public’s knowledge and attitude towards hepatitis B infection.

Potential for establishing an injury surveillance system in India: a review of data sources and reporting systems

BackgroundUnintentional injuries account for 10% of deaths worldwide; the majority due to road traffic injuries, falls, drowning, poisoning and burns. Effective surveillance systems provide evidence for informed injury prevention and treatment and improve recovery outcomes. Our objectives were to review existing sources of unintentional injury data, and quality of the data on the burden, distribution, risk factors and trends of unintentional injuries in India and to describe strengths and limitations of health facility-based data for potential use in injury surveillance systems.MethodsWe searched national and international organisations’ websites to identify unintentional injury-related mortality and morbidity data sources in India. We reviewed and evaluated data collection methods for surveillance attributes recommended by World Health Organization (WHO). We visited health facilities at all levels from public and private sectors, emergency transport centres, insurance offices and police stations in settings reporting significant number of injuries. In these sites, we interviewed key stakeholders using an explorative approach on current data collection processes and challenges to establishing an injury surveillance system based on WHO guidelines.ResultsMajor gaps were highlighted in injury mortality and morbidity data in India, including ill-defined causes of injury deaths and lack of standardisation in classification and coding. Site visits revealed that reporting standards of injuries varied, with issues around clarity of definitions, accountability, time points and lack of reporter/coder training. Major challenges were lack of dedicated staff and training.ConclusionsThere is an important need to build human resource capacity, integrate data sources, standardise and streamline data collected, ensure accountability and capitalise on digital health information systems including insurance databases.

Implications of COVID-19 Pandemic for Health Financing System in Ghana

This article examined the impact of the COVID-19 pandemic on the health financing system in Ghana. The COVID-19 pandemic presents two different crises—a health crisis and an economic crisis, and these have implications for the health financing system in Ghana. The pandemic is likely to have adverse effects on the various sources of healthcare financing, including government support, donor support, national health insurance scheme (NHIS) and out-of-pocket payments, which will impact the general delivery of healthcare in the country. Government support to the health sector in general is likely to be rechannelled into fighting the pandemic considering the declining tax and other non-tax revenues as well as huge expenditure commitment. Donor support is also likely to be scaled down and existing funds redirected into dealing with the COVID-19 pandemic. The NHIS will be affected, as many subscribers are not likely to renew their health insurance policies because of the fear of contracting the coronavirus when they visit health facilities. Also, the non-attendance at health facilities by health consumers will impact out-of-pocket payments and the hospitals’ ability to generate sufficient internal resources for their operations. A number of useful recommendations are proffered with the aim of improving health financing system in Ghana during and post-COVID-19 pandemic.

Community-Based Health Insurance Membership Dropout Rate and Associated Factors in Dera District, Northwest Ethiopia.

BackgroundCommunity-based health insurance is an emerging strategy for providing financial protection against health-related poverty. They have developed into alternative health financing mechanisms for out-of-pocket expenses in low- and middle-income countries. Hence, the aim of this study was to assess the drop-out rate of community-based health insurance membership and associated factors in Dera district, Northwest Ethiopia, 2020.MethodsThrough systematic random sampling techniques, a community-based cross-sectional study was conducted on 584 participants. A structured interviewer-based administered questionnaire was used for data collection. EpI data is used for data entry, while SPSS 20 version is used for analysis. P-value <0.2 binary logistic regression was entered into multivariable logistic regression. Variables with a P-value of <0.05 and a 95% confidence level were considered to be significantly associated with the outcome variable.ResultsThe CBHI dropout rate in the district is calculated to be 37.3% (95% CI: 34, 41%) in the district. Length of enrollment, ≥4 years in the CBHI program (AOR=0.39, 95% CI: 0.26, 0.59), households visit the health facilities 4–6 times a year (AOR=1.92, 95% CI: 1.10, 3.32), have no access to the hospital (AOR=1.68, 95% CI: 1.02, 2.77), knowledge of CBHI (AOR=1.93, 95% CI: 1.32, 2.82) and official position holder for decision-making in the households (AOR=2.07, 95% CI: 1.33, 3.23) were factors associated with CBHI dropout rate in the scheme.ConclusionThis finding confirmed that the CBHI dropout rate in the district was high. Length of enrollment, health facility visit, hospital accessibility, knowledge of CBHI, and official position holders used for decision-making are significantly associated with the CBHI dropout rate. Therefore, emphasis should be given on improving members’ understanding of the CBHI package of benefits; increasing access to hospitals and empowering women will increase the utilization of CBHI. In addition, the quality of care for CBHI patients can be improved when they had access to health services.

Correlates of antenatal care utilization among women of reproductive age in sub-Saharan Africa: evidence from multinomial analysis of demographic and health surveys (2010\u20132018) from 31 countries

BackgroundDespite a global reduction of about 38% in maternal mortality rate between 2000 and 2017, sub-Saharan Africa is still experiencing high mortality among women. Access to high quality care before, during and after childbirth has been described as one of the effective means of reducing such mortality. In the sub-region, only 52% of women receive at least four antenatal visits. This study examined the factors influencing antenatal care utilization in sub-Saharan Africa.MethodsData from Demographic and Health Surveys (DHS) of 31 countries involving 235,207 women age 15–49 years who had given birth to children within 5 years of the surveys were used in the study. Multinomial logistic regression model was applied in the analysis.ResultsAbout 13% of women in sub-Saharan Africa did not utilize antenatal care while 35 and 53% respectively partially and adequately utilized the service. Adequate utilization of antenatal care was highest among women age 25–34 years (53.9%), with secondary or higher education (71.3%) and from the richest households (54.4%). The odds of adequate antenatal care utilization increased for women who are educated up to secondary or higher education level, from richest households, working, living in urban areas, exposed to media and did not experience problem getting to health facility or obtaining permission to visit health facility.ConclusionsThis study has revealed information not only on women who did not utilize antenatal care but also on women who partially and adequately utilized the service. The study concluded that the correlates of antenatal care utilization in sub-Saharan Africa include socioeconomic and demographic factors, getting permission to visit health facility, unwillingness to visit health facility alone and problem encountered in reaching the health facility.

Targeting and Impact of National Health Insurance Program in Indonesia

National Health Insurance System (NHIS) program in Indonesia has been launched since 2014,and government spending to support the program has allocated nearly 40% of MoH budget,especially for the NHIS subsidies. This study examined the distribution of NHIS subsidizedbeneficiaries which associated with the household income distribution, and also studied about theutilization rate of health care facilities among the residents since the NHIS program has introducedto change citizens’ health seeking behaviour from traditional services to health facilities. Using the2016 Susenas data, this study employed the benefit incidence analysis method to measure thedistribution of NHIS-subsidized group, and logistic regression analysis to determine the health careseeking behavior. The result shows that households in higher income (quantile III-V) get benefitfrom government subsidy on NHIS program. It indicated there was a leakage on governmentbudget that not belong to the target (quantile I and II). Then, logistic regression analysis found thatpeople with higher income and having health insurance tend to visit health care facilities morefrequently than lower income group and uninsured people. This can be concluded that healthinsurance ownership is one of the important factors to influence people visiting health carefacilities.

Contraceptive use and its determinants among adolescent women in Tigray, Ethiopia: a multilevel modeling.

Adolescent women are central for intergenerational health of human populations. Adolescent women are the most vulnerable to a range of reproductive health problems. One of the leading causes of death for adolescent women is complications from childbirth and pregnancy. Contraceptive prevents the occurrence of unwanted pregnancies and its complications, thus potentially lower the death rate for adolescent women. However, contraceptive use assumed to be affected by multilevel factors thus needs statistical modeling that account the effect of these factors. Understanding multilevel factors affecting contraceptive use among adolescent women is important for improving the access to and quality of health services. The aim of this study was to assess the contraceptive use and its multilevel determinants among adolescent women in Tigray region. A community based cross-sectional study was conducted. Women who were 15-19 years of age residing in the selected households at the time of data collection were included in the survey. Multi-stage cluster sampling was used to select study units. A multivariable two-level mixed effect binary logistic regression model was fitted to assess the effect of the explanatory variables on contraceptive use. A total of 1,755 adolescent women were participated. Of these 12.3% were contraceptive users. Pills (40%) and intrauterine device (30%) were commonly used contraceptive methods. Educational level, schooling, marital status, age, being informed about contraceptive, health facility visit, duration of stay at their residence, having partner and hearing of contraceptive use message through media were the most important determinants for use of contraceptive among adolescent women. Study participants who were not at school currently had more likely to use contraceptive methods compared to those who were at school (Adjusted odds ratio [AOR]=2.05; 95% confidence interval [CI]: 1.502, 4.183). Similarly, adolescent women who had no history of health facility visit had less likely to use contraceptive methods than those have history of health facility visit (AOR=0.057; 95% CI: 0.034, 0.096). Adolescent women who heard of contraceptive through median had two times (AOR=2.103; 95% CI: 1.207, 3.664) more likely to use contraceptive methods than those not heard contraceptive through media. The factors affecting use of contraceptive method among adolescent women were educational level, schooling, marital status, age, being informed about contraceptive, health facility visit, duration of stay at their residence, having partner and hearing of contraceptive use message through media. This study recommends that in order to increase use of contraceptive method among adolescent women, interventions should continue like the promotion of contraceptive methods through media.

The association between Internet use and health outcomes in the population of older adults

Abstract Background The Internet has become one of the primary sources of health-related information. Less is known about the impact of Internet access and use on health-related outcomes in the older population, which frequently suffer from a digital divide. The main objective of this study was the assessment of the associations between Internet use and variables reflecting health status, the use of health services and health behaviours in the population at least 50 years old. Methods The analysis was carried out on the data set from the telephone-based survey in a sample of 1000 respondents representative for targeted age strata of Polish society. The effects of Internet use were assessed with logistic regression models after adjusting for key socioeconomic variables. Results Mean age (standard deviation) of respondents was 64.2 (9.6). In the study group, 51.1% respondents were Internet users, 19.4% - persons with disabilities, 21.2% were hospitalised at least once, and 51.0% visited health care facilities at least six times in preceding 12 months. The respondents being Internet users less frequently reported chronic diseases (OR, 95%CI: 0.21, 0.16-0.30), disability status (0.52, 0.37-0.72) and higher self-assessed health status (1.64, 1.24-2.16). They also less often used health services in the preceding 12 months (0.77, 0.60-0.99. Internet use was not associated with hospital admission in the preceding year (1.04, 0.76-1.41) and most of the health behaviours (smoking: 1.06, 0.77-1.45, physical activity: 0.85, 0.63-1.15, the consumption of fruits and vegetables: 0.73, 0.50-1.07). Interestingly, Internet users drunk more alcohol (1.52, 1.14-2.02). Conclusions In the population of older adults, the use of the Internet is associated with variables reflecting health status and the utilisation of health services. Higher health status and lower prevalence of chronic conditions among Internet users were found after adjusting for age and other socioeconomic factors. Key messages It was shown that Internet use may be related with more favourable health outcomes. The reported association should trigger further research on the impact of Internet in elderly persons.

Comparison of a Novel Rapid Lateral Flow Assay to Enzyme Immunoassay Results for Early Diagnosis of Coccidioidomycosis.

Coccidioidomycosis (CM) is a common cause of community-acquired pneumonia where CM is endemic. Manifestations include self-limited pulmonary infection, chronic fibrocavitary pulmonary disease, and disseminated coccidioidomycosis. Most infections are identified by serological assays including enzyme-linked immunoassay (EIA), complement fixation, and immunodiffusion. These are time-consuming and take days to result, impeding early diagnosis. A new lateral flow assay (LFA; Sōna; IMMY, Norman, OK) improves time-to-result to 1 hour. We prospectively enrolled 392 patients with suspected CM, compared the LFA with standard EIA and included procalcitonin evaluation. Compared with standard EIA, LFA demonstrates 31% sensitivity (95% confidence interval [CI], 20-44%) and 92% specificity (95% CI, 88-95%). Acute pulmonary disease (74%) was the most common clinical syndrome. Hospitalized patients constituted 75% of subjects, and compared with outpatients, they more frequently had ≥3 previous healthcare facility visits (P = .05), received antibacterials (P < .01), and had >3 antibacterial courses (P < .01). Procalcitonin (PCT) was <0.25 ng/mL in 52 (83%) EIA-positive patients, suggesting infection was not bacterial. When CM is a possible diagnosis, LFA identified nearly one-third of EIA-positive infections. Combined with PCT <0.25 ng/mL, LFA could reduce unnecessary antibacterial use by 77%.

Home delivery of medication as part of reducing congestion in primary healthcare in Tshwane District Health Services

Background. Congestion at health facilities poses the risk of extensive spread of the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) to patients at high risk for severe illness and death due to this infection. During the lockdown to control the spread of the virus, many patients with chronic conditions are not visiting health facilities and not collecting their chronic medication. To improve adherence to medication, home delivery of medication was instituted for patients with chronic diseases who had been receiving care at the Skinner Street Clinic in Tshwane. Objective. To support patients with chronic diseases who were unable to collect their medication, by remotely consulting (telehealth) and delivering their medication during the lockdown due to the COVID-19 pandemic. Methods. Patients were identified for potential home delivery of medication from the clinic appointment book. Their files were retrieved, and they were telephoned and offered the option of receiving medication through home delivery instead of attending a health facility. For those who qualified and accepted home delivery, files were sent to the clinic pharmacy. Medication parcels were prepared and sent to ward-based outreach teams to deliver to patients. Relevant information was captured on the Qualtrics platform. Results. A total of 1 727 files were evaluated. Of these patients, 60% were on treatment for HIV infection, and 19% for hypertension. A total of 32% ( n =547) were eligible for home delivery of medication, but only 25% of the 1727 patients accepted the home delivery of medication. Almost 25% could not be contacted. Compared with those with non-communicable diseases (NCDs) or a combination of HIV and one or more NCDs, a higher proportion of HIV-positive patients with no other diagnosis chose not to have their medication delivered at home. Patients using the service expressed their appreciation and requested that it be extended to others. Conclusion. Home delivery of medication has significant advantages for patients. It can ensure that patients continue to adhere to their chronic medication in the midst of the COVID-19 epidemic, without increasing their risk of contracting the virus. Expanding the home delivery of medication to more facilities while aligning it with the Centralised Chronic Medicine Dispensing and Distribution programme has the potential to alleviate the congestion and workload of primary care facilities while these are under severe pressure owing to the COVID-19 pandemic.

Factors affecting mothers’ intentions to visit healthcare facilities before hospitalisation of children with pneumonia in Biliran province, Philippines: a qualitative study

Background and objectivesDespite a substantial reduction in the mortality rate of children under 5 years in the past 25 years, pneumonia remains the single-largest infectious cause of child deaths worldwide....

Explaining Differences in the Acceptability of 99DOTS, a Cell Phone-Based Strategy for Monitoring Adherence to Tuberculosis Medications: Qualitative Study of Patients and Health Care Providers.

Background99DOTS is a cell phone–based strategy for monitoring tuberculosis (TB) medication adherence that has been rolled out to more than 150,000 patients in India’s public health sector. A considerable proportion of patients stop using 99DOTS during therapy.ObjectiveThis study aims to understand reasons for variability in the acceptance and use of 99DOTS by TB patients and health care providers (HCPs).MethodsWe conducted qualitative interviews with individuals taking TB therapy in the government program in Chennai and Vellore (HIV-coinfected patients) and Mumbai (HIV-uninfected patients) across intensive and continuation treatment phases. We conducted interviews with HCPs who provide TB care, all of whom were involved in implementing 99DOTS. Interviews were transcribed, coded using a deductive approach, and analyzed with Dedoose 8.0.35 software (SocioCultural Research Consultants, LLC). The findings of the study were interpreted using the unified theory of acceptance and use of technology, which highlights 4 constructs associated with technology acceptance: performance expectancy, effort expectancy, social influences, and facilitating conditions.ResultsWe conducted 62 interviews with patients with TB, of whom 30 (48%) were HIV coinfected, and 31 interviews with HCPs. Acceptance of 99DOTS by patients was variable. Greater patient acceptance was related to perceptions of improved patient-HCP relationships from increased phone communication, TB pill-taking habit formation due to SMS text messaging reminders, and reduced need to visit health facilities (performance expectancy); improved family involvement in TB care (social influences); and from 99DOTS leading HCPs to engage positively in patients’ care through increased outreach (facilitating conditions). Lower patient acceptance was related to perceptions of reduced face-to-face contact with HCPs (performance expectancy); problems with cell phone access, literacy, cellular signal, or technology fatigue (effort expectancy); high TB- and HIV-related stigma within the family (social influences); and poor counseling in 99DOTS by HCPs or perceptions that HCPs were not acting upon adherence data (facilitating conditions). Acceptance of 99DOTS by HCPs was generally high and related to perceptions that the 99DOTS adherence dashboard and patient-related SMS text messaging alerts improve quality of care, the efficiency of care, and the patient-HCP relationship (performance expectancy); that the dashboard is easy to use (effort expectancy); and that 99DOTS leads to better coordination among HCPs (social influences). However, HCPs described suboptimal facilitating conditions, including inadequate training of HCPs in 99DOTS, unequal changes in workload, and shortages of 99DOTS medication envelopes.ConclusionsIn India’s government TB program, 99DOTS had high acceptance by HCPs but variable acceptance by patients. Although some factors contributing to suboptimal patient acceptance are modifiable, other factors such as TB- and HIV-related stigma and poor cell phone accessibility, cellular signal, and literacy are more difficult to address. Screening for these barriers may facilitate targeting of 99DOTS to patients more likely to use this technology.

Evaluation of the feasibility and effectiveness of a health facility-based combined with home-based early childhood development intervention in Siaya County, Kenya: a cluster-randomized control trial

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Approximately 250 million (43%) children under five years in low- and middle-income countries are at risk of sub-optimal development. Of these, 67% are found in sub-Saharan Africa due to exposure to multiple risks, including inadequate stimulation at home. In order to promote early childhood development (ECD), an intervention integrating ECD content into routine facility-based health services and supporting ECD policy and advocacy is currently being implemented in Siaya County. In addition, parental counseling on early stimulation is integrated into home-based visits by community health volunteers. We aim to evaluate the intervention’s operational feasibility, effectiveness and cost-effectiveness.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study is a cluster-randomized controlled trial using a mixed-methods approach. The study is being conducted in Bondo sub-county in Siaya County. The study has three arms. Arm 1 will receive a health facility-based ECD intervention. Arm 2 will receive the health facility-based ECD intervention combined with home-based ECD counselling. Arm 3 (control) will receive standard care. Six health facilities in each study arm (18 in total) will be randomly selected from wards within the sub-county. We aim to recruit and follow-up 699 mother/caregiver-child dyads, 233 in each arm. Pregnant women are recruited when they visit health facilities during the third trimester. Analysis will involve estimating the effect of the intervention using mixed linear models and the Difference-in-Differences estimator.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The data generated from this study will provide much-needed information for program design and implementation of interventions aimed at promoting ECD in Kenya and other sub-Saharan African countries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial Registration:&lt;/strong&gt; Current Control Trial is ISRCTN11561283.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster‐randomised controlled trial of the CHoBI7 mobile health program

The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members. A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The 'Standard Message' Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The 'Health Facility Visit+Soapy Water' Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The 'Health Facility Visit+Handwashing Station' Arm received this same intervention plus a small plastic handwashing station. Within 24h of intervention delivery, three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members. Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit+Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14). These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.

Effect of Health Information Websites on Healthcare Facility Visits in the Eastern Province of Saudi Arabia

Introduction: The internet has been widely available with 18 million users in Saudi Arabia alone. The rapid growth of internet use has proven to affect healthcare. The main objective was to determine a correlation between health-related information (HRI) website use &amp; healthcare facility visits in the Eastern Province of Saudi Arabia.Methodology: This study was designed as a survey-based cross-sectional study involving the population of the Eastern province of Saudi Arabia. Data was collected by distributing a validated survey via an online survey application over a 4-month period. It consisted of demographic data and questions concerning internet use for HRI. Logistic regression was used to establish a correlation between internet use for HRI &amp; healthcare facility visits and to see influencing factors.Results: From the 1095 replies, 788 fit our inclusion criteria. 90% of our subjects have used the internet for HRI using mainly General medical websites 47.9%, Social Media 20.17%, Forums 19.16%, and government websites 12.69%. We found 52.27% have used HRI websites to diagnose &amp; treat their own medical conditions without professional medical advice. Visiting healthcare facilities after reading online HRI occurred 62.2% of the time, while the remaining did not due to being reassured of their condition. Outpatient clinics were most visited at 57.63% followed by ER &amp; Pharmacy visits at 21.11% each. Those who have used the internet for HRI were more likely to visit a healthcare facility than those who haven't (OR(95%CI)) 2.05(1.24-3.36) (p-value&lt;0.05).Conclusions: There seems to be a correlation between HRI website use &amp; healthcare facility visits, which is influenced by the level of education &amp; occupation status.

Spatio-temporal distribution and associated factors of home delivery in Ethiopia. Further multilevel and spatial analysis of Ethiopian demographic and health surveys 2005\u20132016

BackgroundGlobally, between 2012 and 2017, 80% of live births occurred at health facilities assisted by skilled health personnel. In Ethiopia, in 2016 only 26% of live births attended by skilled health personal. This study aimed to assess the spatial patterns and associated factors of home delivery in Ethiopia using 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys.MethodsA total of 33,482 women who gave live birth in the 5 years preceding each survey were included for this study. ArcGIS version 10.7 software was used to visualize the spatial distribution of home delivery. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with home delivery. A p-value < 0.05 was taken to declare statistically significant predictors.ResultsHome delivery was declined from 94.78% in 2005, 90.05% in 2011, and 73.44% in 2016 in Ethiopia. Among the three surveys, consistently high clustering of home delivery was observed in Amhara and Southern Nations Nationalities and People’s Regions (SNNPR) of Ethiopia. In spatial scan statistics analysis, a total of 128 clusters (RR = 1.04, P-value < 0.001) in 2005, and 90 clusters (RR = 1.11, P-value < 0.001) in 2011, and 55 clusters (RR = 1.29, P-value < 0.001) in 2016 significant primary clusters were identified. Educational status of women and husband, religion, distance to the health facility, mobile access, antenatal care visit, birth order, parity, wealth index, residence, and Region were statistically significant predictors of home delivery.ConclusionThe spatial distribution of home delivery among the three consecutive surveys were non-random in Ethiopia. Educational status of women and husband, religion, distance to the health facility, wealth index, residence, parity, mobile access, Region, and antenatal care visit were statistically significant predictors of home delivery in Ethiopia. Therefore, an intervention needs to improve the coverage of antenatal care visit, and health care facilities. Ministry of health and other stakeholders should give special attention to women living in Amhara and SNNPR states of Ethiopia.