The Effect of Community Health Information System on Health Care Services Utilization in Rural Ethiopia

BACKGROUND: The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services. However, this program is not comprehensively evaluated. MATERIALS AND METHODS: The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584) _, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179) from 62 randomly selected woredas. As part of the comprehensive assessment. OUTPUT AND RESULTS: The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards. CONCLUSIONS: The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 2020­2035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers.

Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based CrossSectional Stud

BACKGROUND: Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home. METHODS: A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness. RESULTS: Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation. CONCLUSIONS: The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections

Self-leadership of nurses in a critical care outreach service: The development of a conceptual framework

Background: Globally, critical care outreach services (CCOS) were implemented in health care facilities; however, compliance with guidelines is poor. The authors have noticed that a gap exists in the literature on how self-leadership might influence nurses' implementation of CCOS. Self-leadership is about leadership applied to oneself. Critical care outreach services assist nurses with the nursing care of a patient whose health is declining. Leadership is needed for the successful implementation of CCOS. Aim: This article aims to outline the method the authors followed for developing the conceptual framework for how self-leadership amongst nurses influenced the functioning of CCOS. Setting: The research was conducted at a private hospital in Pretoria. Methods: A qualitative approach was followed to provide an accurate description of nurses' experiences on their self-leadership in a CCOS. The practice-oriented theory of Dickoff (1968) was the reasoning map for developing and constructing the conceptual framework. Results: Bedside nurses experienced the following self-leadership strategies: constructive thought patterns, natural rewards and behaviours focused on their implementation of CCOS. Conclusion: The conceptual framework was part of another study and provided the authors with a rationale that guided the authors with the development of self-leadership strategies in a CCOS. Contribution: The conceptual framework provided the authors with an understanding of how nurses' self-leadership influenced the implementation of CCOS. The conceptual framework can also assist in developing training programmes for nurses to improve their self-leadership and ultimately improve nurses' competence in providing quality nursing care to patients.

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

Knowledge and Attitude towards Pregnancy Care and Delivery among Male Commercial Motorcyclists in Ibadan, Nigeria

Background: Men's influences are gradually being recognised in pregnancy and delivery care. The study aims to determine the knowledge and attitude of male commercial motorcyclists on pregnancy care and delivery of women. Materials and Methods: This cross-sectional study was conducted among married male commercial motorcyclists, operating in Ibadan North Local Government Area selected using a cluster sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS version 16. Each section was evaluated using rating of a three-point Likert scale with each item scored based on responses ranging from disagree to agree. Results were presented in tables and charts. Results: Four hundred and fifty three male commercial motorcyclists were interviewed. The mean age was 34.2±7.3years, 301 (66.4%) had secondary education, while 390 (86.1%) were in a monogamous marriage. Thirty 30(6.6%) respondents did not know when their wives registered for ANC while majority, 444(98.1%) did not know the duration of their wives' labour. Few respondents 46 (10.2%) recognized vaginal bleeding as a common danger signs in pregnancy while 277 (61.1%) agree that women should have at least four ANC visits before delivery. Many of the respondents 315 (69.6%) had good knowledge, and 304 (67.1%) had positive attitude towards antenatal and delivery care. Conclusion: Educational efforts on maternal health care should also focus on the men to improve their knowledge, attitude and involvement in antenatal and pregnancy.

Cost of treatment among self-referred outpatients in referral hospitals compared to primary health care facilities in East Wollega, western Ethiopia: a comparative cross-sectional study

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities

Continuity of care of outpatients with schizophrenia in Pretoria

Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their compliance-related needs as well as psychosocial and aftercare treatment needs. Results. Compliance needs: Eighty-three per cent of the participants supported their medication treatment and aftercare, but needed more information on the illness than they had received or had managed to gather. Psychosocial needs: Participants had difficulty in accepting the illness and in understanding its consequences for their everyday functioning. Ninety-seven per cent of patients were aware that their illness had affected the health of their primary caregiver. The majority of participants had lost friendships since the diagnosis of schizophrenia. Eighty-eight of the primary caregivers supported the patient financially, despite the fact that many were over 60 years of age. Aftercare treatment needs: A strong need was expressed for services such as day-care centres, workshops, and psychoeducational and social work services. Conclusions. As South African health policy is moving towards de-institutionalisation and treating mental health as part of primary care; support must be improved for sufferers of schizophrenia and their primary caregivers. Many people are prepared to face up to the challenge of caring for a mentally ill family member, yet are faced with significant needs that should be addressed

Prescription ambulatoire des antibiotiques chez l'adulte

Notre travail est une etude prospective realisee dans six formations sanitaires peripheriques d'Abidjan qui a permis d'evaluer les caracteristiques de la prescription ambulatoire des antibiotiques chez l'adulte au cours de l'annee 2003. 251 ordonnances delivrees dans ces formations sanitaires ont ete analysees. Il ressort de cette etude que : *L'age moyen des patients est de 29 ans avec un sex-ratio de 0;66 ; *14;7pour cent des patients beneficiaient d'une assurance maladie ; *66;53 pour cent des ordonnances ont ete redigees par des paramedicaux ; *Les motifs de prescription sont surtout la presence d'un infectieux (63;3pour cent) et/ou d'une fievre (26;7pour cent) ; *La realisation des examens paracliniques etait faible (10pour cent) ; *Les infections respiratoires representaient 36;8pour cent des pathologies etudiees ; *La Bronchite (16pour cent) est l'infection respiratoire la plus frequente; suivie des infections sexuellement transmissibles (11pour cent) ; *Le nombre moyen de LP est de 3;05 ; *Les antibiotiques constituent 42;76pour cent des LP ; *La monotherapie etait de mise dans 74pour cent des cas ; *43;7 pour cent des LP des antibiotiques sont des Beta-lactamines; 13;9pour cent des Quinolones et 13pour cent.des Imidazoles ;*Le nombre de LP de Penicillines et de Cephalosporines son respectivement de 76;6pour cent et 23;4pour cent ; *Les DCI les - prescrites sont: Amoxicllline (18;3pour cent); Metronidazole (13pour cent); TMP-SMX (6;2pour cent); Doxycycline (6;2pour cent) ; *La duree moyenne de l'antibiotherapie est de 7;6 Jours ; *43pour cent des LP des antibiotiques sont des generiques ; *41;4pour cent des prescriptions sont Irrationnelles ; *Le cout moyen d'une ordonnance est de 14952 F CFA ;*Le cout moyen de l'antibiotherapie est de 9590 F CFA. Au terme de cette etude quelques propositions ont ete formulees visant a une rationalisation de l'antibiotherapie

Evaluation d'un modele de reduction de la frequence des occasions manquees de vaccination dans une formation sanitaire urbaine d'Abidjan en Cote d'Ivoire

Vue la place privilegiee qu'occupent les etablissements sanitaires de premier contact dans le processus de developpement sanitaire; leur performance vis a vis de l'integration des activites doit etre developpee. L'integration des actes au niveau de ces structures permet au personnel de mieux exploiter le temps dont il dispose et d'effectuer; de facon harmonieuse; plusieurs fonctions. La frequence des occasions manquees de vaccination est un bon indicateur des difficultes d'integration des activites au sein des structures sanitaires. Notre etude se proposait de verifier l'hypothese selon laquelle l'augmentation des competences du personnel dans un milieu de travail mieux organise; pourrait contribuer a ameliorer la performance des etablissements sanitaires de premier contact. Pour le demontrer; nous nous sommes fixes comme objectif d'evaluer un modele pluri strategique et integre de reduction de la frequence des occasions manquees de vaccination chez les enfants et les femmes en age de procreer. Notre etude s'est deroulee a la Formation Sanitaire Mo-Faitai d'Abobo-Doume. Il s'agit d'une etude d'intervention avec evaluation avant et apres des indicateurs choisis. Pour l'acquisition des competences nous avons fait une formation continue; .de courte duree (une semaine); a l'integration de 1a vaccination dans la prestation de soins. L'amelioration du cadre de mise en ouvre a ete obtenue grace a la technique de la negociation. Nos resultats ont montre globalement une amelioration de la performance traduite par une diminution importante de la frequence des occasions manquees de vaccination. Celle-ci est passee de 63;7 pour cent a 22;9 pour cent chez les femmes et de 44;1 pour cent a 4;6 pour cent chez les enfants. Les taux residuels eleves d'occasions manquees observes chez les femmes apres notre intervention sont essentiellement lies a des reticences individuelles; a des problemes logistiques et peut-etre secondairement au refus de la vaccination par les usagers. La perennite de nos resultats doit etre assuree par une bonne supervision. Nous proposons la generalisation de notre modele a l'ensemble des structures sanitaires de premier contact en Cote d'ivoire; Par ailleurs; cette etude peut servir de base de recherche sur l'efficacite des structures sanitaires

Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi; Mozambique; and Tanzania. Effective cure rates of 86-90 percent were achieved with short-course chemotherapy and of 60-66 percent with standard chemotherapy. The average incremental costs per year of life saved were US $1.7-2.1 for short-course chemotherapy with hospital admission; $2.4-3.4 for standard chemotherapy with hospital admission; $0.9-1.1 for ambulatory short-course chemotherapy; and $0.9-1.3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus; treating HIV-seropositive; tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative; tuberculosis-smear-positive patients