Level of health data quality and information use, and contributing factors in the Benishangul Gumuze Region, west Ethiopia: using social ecological framework

Background: Creating responsibility for quality healthcare data and utilization are among the basic functions of leadership. While the benefits of data quality and use are well known, the evidence around the role of healthcare information systems leadership and governance in sustaining data demand and use is limited. Therefore, this study aimed to investigate the level and contributing factors of health data quality and information use in Assosa district, Benishangule Gumuze Region. Methods: A mixed approach design, using qualitative exploration and a facility-based quantitative cross-sectional approach was used. Seventeen departments from two health facilities were enrolled for the quantitative component, while 28 in-depth interviews were conducted to complete the qualitative part of the study. A phenomenological approach was used to explore factors influencing the quality and use of health data. Quantitative data was analyzed descriptively using tables and graphs, whereas qualitative data was analyzed using content analysis guided by the framework for the social ecological model. Results: The average levels of information use and report accuracy were 38.6 and 119.33, respectively. Three themes emerged, explaining the main factors that influence quality data generation: individual characteristics, facility and environmental factors, and leadership and governance characteristics. Individual characteristics were motivation, capacity building, commitment, and digital literacy, while facility and environmental factors included infrastructure, healthcare information system resources and supportive supervision. Furthermore, among the leadership and governance related factors, healthcare data, assigning the right person, and system regulation were some of the factors which were identified. Conclusions: The level of health data quality and its utilization was low during the Asossa city adminstration. The unfriendly physical and organizational working environments and high staff turnover which negatively affected the leadership and governance of the health system are some of the reasons which were sighted with regards to the poor quality of data and information use. Therefore, interventions that have multifaceted effects on data quality and use, such as improving leadership and governance practices and behavior should be implemented. [Ethiop. J. Health Dev. 2022;36 (SI-1)]

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19

Background: People with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities. Objectives: To explore the perspectives and experiences of people with disabilities in accessing health services in Zimbabwe during the pandemic, to identify perceived challenges and facilitators to inclusive health and key actions to improve accessibility. Methods: We used in-depth interviews with 24 people with disabilities (identified through purposive sampling) and with 10 key informants (from expert recommendation) to explore the impact of COVID-19 on access to health care. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health 'Missing Billion' framework to map and inform barriers to inclusive health care during COVID-19 and disparities in outcomes faced by people with disabilities. Results: People with disabilities demonstrated good awareness of COVID-19 mitigation strategies, but faced difficulties accessing COVID-19 information and health services. Challenges to the implementation of COVID-19 guidelines related to a person's functional impairment and financial ability to do so. A key supply-side constraint was the perceived de-prioritisation of rehabilitation services. Further restrictions on access to health services and rehabilitation decreased an individual's functional ability and exacerbated pre-existing conditions. Conclusion: The immediate health and financial impacts of the COVID-19 pandemic on people with disabilities in Zimbabwe were severe. Government departments should include people with disabilities in all communications and activities related to the pandemic through a twin-track approach, meaning inclusion in mainstream activities and targeting with specific interventions where necessary.

Atlas des statistiques sanitaires africaines 2022: Analyse de la situation sanitaire de la Région africaine ­ Profils Pays

NA

Rural­urban health disparities among older adults in South Africa

Background: There are limited studies assessing rural­urban disparities among older adults in Africa including South Africa. Aim: This study explores rural­urban health disparities among older adults in a population-based survey in South Africa. Setting: Data for this study emanated from the 2008 study on 'Global Ageing and Adult Health (SAGE) wave 1' (N= 3280) aged 50 years or older in South Africa. Methods: Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression. Results: Rural dwellers were more likely to be older, black African and had lower education and wealth than urban dwellers. Rural and urban dwellers reported a similar prevalence of self-rated health status, quality of life, severe functional disability, arthritis, asthma, lung disease, hypertension, obesity, underweight, stroke and/or angina, low vision, depression, anxiety and nocturnal sleep problems. Adjusting for socio-demographic and health risk behaviour variables, urban dwellers had a higher prevalence of diabetes (OR: 2.36, 95%CI:1.37, 4.04), edentulism (OR: 2.79, 95% CI: 1.27, 6.09) and cognitive functioning (OR: 1.91, 95% CI: 1.27, 2.85) than rural dwellers. Conclusion: There are some rural­urban health disparities in South Africa, that is, urban dwellers had a higher prevalence of diabetes, edentulism and cognitive functioning than rural ones. Understanding these rural­urban health variations may help in developing better strategies to improve health across geolocality in South Africa

Tracking progress on the health status and service delivery outcomes for neonates and children in the Metro West geographic service area of the Cape Metropole, 2010 - 2015

Background. Monitoring the health status of populations of children is one of the building blocks of the health system. The provision of an indicator dashboard with disaggregated data that are collected over time can be used to gauge the performance of the health system, guide the allocation of resources and prioritise health interventions within districts.Objectives. To determine neonatal and child mortality, morbidity and health service outcomes over a 6-year period in the Metro West geographic service area (GSA) of the Cape Town metropole.Methods. A dashboard with key indicators was developed using existing data.Results. From 2010 to 2015, there was a decrease in the perinatal mortality rate from 31.7 to 24.8 per 1 000 deliveries, and the early neonatal and neonatal mortality rates from 7.8 and 8.6 to 7.0 and 8.2 per 1 000 live births, respectively. The main obstetric causes of early neonatal deaths were antepartum haemorrhage (22 - 24%) and unexplained intrauterine death (13 - 16%); the main neonatal causes were immaturity (17 - 34%), congenital abnormalities (23 - 29%) and hypoxia (23 - 26%). Under-five mortality decreased in 2013 from 25 to 22 per 1 000 live births, with the main causes being neonatal conditions (32%), pneumonia (25%), congenital abnormalities (9%), injuries (8%) and diarrhoea (8%). Fifty percent of child deaths were out of hospital, with pneumonia and diarrhoea accounting for more than half of these. There was an improvement in health service coverage rates in 2015: immunisation <1 year old (99%); measles second dose (85%), pneumococcal third dose (100%) and rotavirus second dose (100%); maternal antiretroviral coverage (90%); HIV testing in mothers (93%); HIV DNA polymerase chain reaction testing in babies (97%); and a decrease in HIV transmission (2%). Exclusive breastfeeding coverage rates at 14 weeks, and vitamin A supplementation at 12 - 59 months, were only 30% and 44%,respectively, across the GSA.Conclusion. There was a decrease in perinatal, early neonatal, infant and under-five mortality in Metro West over the 6 years. Further reductions in under-five mortality will require focusing on interventions to reduce neonatal and out-of-hospital deaths across the service delivery platform. Home visits to at-risk mothers and infants by community health workers could prevent out-of-hospital deaths and improve exclusive breastfeeding and vitamin A coverage. This will require increasing the number of community health workers and broadening their scope of practice

Mental health status of students attending tertiary institutions in Bayelsa State, Nigeria

National health policies that take into cognizance the interventions against the menace of students' ill health in Nigeria are limited. This study investigated the health status of students in tertiary institutions in Bayelsa State. A descriptive study design was adopted to randomly select four tertiary institutions out of six. Two hundred students were randomly selected from the four schools; fifty from each school. Structured questionnaires containing symptoms-specific ill health were distributed to the selected students. One hundred and fifty-five questionnaires used for the analyses were retrieved. Thirty six specific health symptoms perceived by the students were classified following WHO standard. Out of 561 students-symptoms, 35.6% were mental health while 34.6% were infectious. More female (66.53%) than male (60.14%) showed mental health symptoms. The differences were not significant (P>0.05). Students who had lived in urban location had more mental than those that resided in rural location. The differences were significant (P<0.05). The symptoms decreases as age increased. 60.1% of the students developed these health challenges as they got admitted into schools while 39.9% of the students had the problem at home before admitted to the school. The symptoms of the student's mental health increased as parents' income improved. The implication of these results is a cause for prompt public health intervention

Oral health status and treatment needs of in-patients of a Nigerian psychiatric hospital

Objective: Mental disorders have been reported to increase the risk to neglect of oral care. The objective of this study was to determine the oral health and treatment needs of psychiatric in-patients and compare with non-psychiatric patients.Methods: This was a cross-sectional study conducted at the Federal Neuro-psychiatric Hospital, Yaba, Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos. A structured questionnaire was administered by investigators to the two groups of participants case group (psychiatric patient) and the control group (dental patient with no psychiatric history). This included mini international neuropsychiatry interview (M.IN.I)questionnaire to ascertain the diagnoses. Other information sought included missing teeth, retained teeth, carious teeth and tooth wear lesions were noted during oral examination. Results: A total of 167 participants were seen (81 were in the control group and 86 in the case group). Age range was from 18-90 years. The mean age was 41.44±14.98 years. All the participants (2.99%) with retained root were in case group. The majority (52.3%) of the participants in case group were dentate (p=0.001). The control group had the highest proportion of participants with good oral hygiene (p= 0.09). Carious teeth (p =0.33) and the number of teeth affected by tooth wear lesion were found to more in the case group (p= 0.02).Conclusion: Psychiatric patients had poor oral health compared to non-psychiatric patients. There was also a higher restorative and surgical treatment need in psychiatric patients

The History of Tuberculosis in Morocco

Whether TB was already spread in Morocco before the French protectorate or was it brought by foreigners; is an interesting debate in the medical history of Morocco. It was common among practitioners who were first interested in the health situation of Moroccans. TB; and especially its pulmonary form; was rather rare in Morocco [3]. In the 19th century; a medical doctor (Despine) who lived in Essaouira; declared the absence of TB in this Moroccan city; which was open for trade with Europeans very early in history

We Keep her Status to ourselves': Experiences of Stigma and Discrimination among HIV-Discordant Couples in South Africa; Tanzania and Ukraine

In HIV-discordant relationships; the HIV-negative partner also carries the burden of a stigmatised disease. For this reason; couples often hide their HIV-discordant status from family; friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention; treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa; Tanzania and Ukraine. During 2008; HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire; while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa; 10 from Tanzania; and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner; few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip; rumours and name-calling; and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system

Knowledge; Attitude and Practices of Employers should they Discover that their Domestic Worker is HIV Positive

Background: Infection with human immunodeficiency virus (HIV) is an epidemic that has become the leading cause of morbidity and mortality in South Africa. HIV/AIDS threatens productivity; profitability and the welfare of employees and their families. Some employers insist on knowing the HIV status of their domestic workers; and there have been reports of discrimination and unfair dismissal when they are found to be infected. Methods: This qualitative study describes the knowledge; attitudes and practices of employers towards HIV-positive domestic workers in Rustenburg. In-depth interviews and a focus group discussion were conducted with 10 purposefully selected participants; all employers of domestic workers. Results: It was found that employers had reasonable knowledge about HIV and AIDS and positive views on accepting and accommodating an HIV-positive domestic worker. While they would not consider dismissal on the basis of HIV status; they were not aware of legal aspects related to HIV-positive domestic workers or how to offer support. They were also not aware of universal precautions to use to prevent HIV transmission. Conclusion : There is a need to provide more information to employers to ensure that HIV-positive domestic workers are reasonably accommodated in their work and have access to appropriate services

The Oral Hygiene Status of Institution Dwelling Orphans in Benin City; Nigeria

Introduction: Orphans like other vulnerable children face a number of challenges including limited or no access to basic health care including oral health care; which is one of their unmet health care needs. Neglected oral health care is associated with the development and progression of periodontal diseases among others. Objective: To determine the oral hygiene status of institution dwelling orphans. Materials and Methods: Thirty eight orphans from four orphanages in Benin City; Edo State of Nigeria were clinically examined and their oral hygiene status determined using the simplified oral hygiene index of Greene and Vermillion (OHI-S). Results: Seventy-three percent of the orphans were found to have fair oral hygiene comprising mostly of those aged 6-13 years. More females were in this category while more males presented with poor oral hygiene status. Conclusion: More orphans presented with fair oral hygiene that indicated inadequate oral care. There was poor oral health education and limited access to services. There is need for these to be improved as a solution to poor oral health status of these vulnerable children

Factors Associated with Disclosure of HIV Status among HIV Positive Children in Rwanda

As the number of treatment-managed cases of pediatric Human Immunodeficiency Virus (HIV) increases; the issue of disclosure has become increasingly important. In this article; we evaluate factors associated with disclosure in Rwanda among HIV-positive children of 7 to 15 years. A 2008 survey in Rwanda was conducted to determine these factors. Participants in the study included 1;034 children on HAART and in the pre-HAART phase; among them 65 knew their HIV status; and 35 were unaware. The child's age was positively associated with awareness of HIV status. Children with illiterate parents were two times (aOR: 2.2; 95 CI: 1.4-3.6) more likely to be disclosed than children with high school educated parents. Children who engaged in dialogue with their parents or other family members were 15 times and four times; respectively; (aOR: 15.2; 95 CI: 9.4- 24.7 and aOR: 4.1; 95 CI: 2.4-6.9) more likely to be disclosed than those who did not. Findings offer ways for Rwanda to improve its approach to disclosure issues; counseling and psychosocial support for HIV-positive children

Eye Screening for Automobile Drivers: The Need to Make It Mandatory Eye Test among Automobile Drivers

Abstract:Objective:To determine ocular health status among automobile drivers in Birnin Kebbi.Methods:Structured questionnaire was used to collect data on automobile drivers' socio-demographiccharacteristics; visual conditions and challenges relevant to adequate visual functions. Also conductedwere eye tests including visual acuity; visual field; colour vision; subjective refraction; pen-light eye examination; funduscopy and applanation tonometry results:Forty-two male automobile drivers with a mean age of 41.7 SD 8.7. All had at least 3 years driving experience and thought eye test was at least necessary before driving. However; only 4 (9.5) ever had an eye test to obtain a driving license. Though;39 (92.9) engaged in daylight and night driving; 5 (11.9) had blurred vision to road side objects; one (2.4) had experienced transient visual obscurations driving and one (2.4) wore corrective eyeglasses while driving. None had difficulty recognizing shades of colours. Four had visual acuity worse than 6/12. Ocular conditions among the drivers' eyes include refractive errors 48;pinguecula 37; pterygium 17; glaucoma 4 and cataract 2. The commonest refractive error was presbyopia.Two drivers had glaucoma and 4 were glaucoma suspects. The care given included counselling 6 (8); prescription 11 (28); and referral for eye care 12 (48).Conclusion:Potentially vision impairing eye conditions exist among automobile drivers and pre-licensing eye test is poorly observed. The need to enforce eye test before the issuance and renewal of driving license is underscored

Predictors of HIV Status Disclosure to Sexual Partners among People Living with HIV/AIDS in Ethiopia

Introduction: Disclosure of HIV positive sero-status to sexual partners; friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of people living with HIV/AIDS never disclose in Ethiopia. This study was carried out to assess the magnitude and factors associated of HIV seropositive status disclosure to sexual partners among peoples living with HIV/AIDS. Methods: A hospital based cross-sectional study was conducted April -June; 2010; among systematically selected 334 HIV patients attending at Woldia hospital; Ethiopia. Data were collected through pre-tested questionnaire; using exit interview. Bivariate and multivariable logistic regression models were fitted to identify associated factors for disclosing their HIV seropostive status to sexual partner. Results: One hundred nineteen nine (59.6) was females; 218(65) was from urban area; 297(85.8) are on antiretroviral therapy. The study found a significant association between higher educational status of the respondents (AOR:0.4; 95CI (0.17-0.92)) and sexual partners (AOR: 9.0; 95 CI(2.8-29.3)); knowing HIV status of sexual partner (AOR:8.1; 95CI(3.4 -19.2)); being on antiretroviral therapy (AOR:7.9; 95 CI(3.42-18.5)); having follow up counseling (AOR:5.26; 95CI(2.2-12.5)); and being tested for HIV in ante natal care clinic (AOR:0.21; 95CI(1.14- 6.46)) with disclosure of HIV status to sexual partner. Conclusion: The study concluded the need for giving more emphasis for the patients who are not on antiretroviral therapy and the need for giving emphasis on techniques how to disclose status to sexual partner

The Physical Activity and Health Status of Two Generations of Black South African Professional Women

Increased health risks associated with physical inactivity in the Black population have been reported in recent years. Black women; suffering the highest levels of inactivity; overweight and obesity; are at greatest risk of developing chronic diseases of lifestyle. This explorative-descriptive study investigated the physical activity patterns and health status of two generations of Black professional women; reflecting pre-democracy and post-democracy age groups. Quantitative measures were used; including the ActiGraph GT1M accelerometer; the Global Physical Activity Questionnaire and the Health-Promoting Lifestyle Profile. Sample groups comprised teachers; nurses; social workers and public sector managers. Participants aged between 35 and 45 years were allocated to the older generation group (n = 111); whilst those aged between 18 and 21 years (students in the mentioned professional fields) were allocated to the younger generation group (n = 69). The results indicated that these women displayed lower levels of health-promoting behavioural practices than expected; significantly lower levels of physical activity and significantly higher levels of overweight and obesity than the South African norms. The observation that the younger group appeared to be replicating the patterns of the older women is a cause of concern. Greater compliance to health-promoting behaviours was expected in this group owing to participants' professional involvement in health; education and social development fields. Wide-ranging initiatives are necessary to promote physical activity and health amongst the Black female population in South Africa

A Survival Analysis of South African Children Under the Age of Five Years

The South African Demographic Health Survey data set (SADHS) of 2003 contains massive individual-level information on South African children under the age of five years selected from a random sample of 7756 households. The data set contains data on socio-economic; demographic; health-related and sanitary variables gathered by using multistage cluster sampling. The objective of the study was to identify key predictors of mortality amongst children under the age of five years. Logistic regression analysis and Cox regression were used for data analysis. Under-five mortality was significantly influenced by three predictor variables (breastfeeding; marital status; and ownership of a flush toilet). The hazard ratio of the variable 'breastfeeding' was 3.09 with P = 0.000 and 95 confidence interval (CI) of (1.899; 5.033). The hazard ratio of the variable 'toilet' was 2.35 with P = 0.016 and 95 confidence interval of (1.172; 4.707). The hazard ratio of the variable 'marital status' was 1.74 with P = 0.035 and 95 confidence interval of (1.041; 2.912). Adjustment was factored in for the mother's level of education and wealth index

A Profile on Health Status and Medical Conditions of Patients Staying Longer than the Set Norm at a District Hospital in South Africa

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative; retrospective; descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients' records with longer than average length of stay; from January to December 2007; were selected by stratified random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases; symptoms; signs etc; and injury; poisoning and consequences of causes yielding more than a third (36and 12; respectively; for each classification). Neoplasm-related admissions; in which cancer was identified as the most prevalent; stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifications ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly influenced by the type of health conditions which are diagnosed. Further research is needed to find influential factors that might contribute to patients staying longer than normal

Mortality and health among internally displaced persons in western Kenya following post-election Violence; 2008: novel use of demographic surveillance

Objective To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. Methods In 2007; 204 000 individuals lived in the DSS area; where field workers visit households every 4 months to record migrations; births and deaths. We collected data on admissions among children 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality; migration and hospitalization rates among IDPs and regular DSS residents were compared; and verbal autopsies were performed for deaths. Findings Between December 2007 and May 2008; 16 428 IDPs migrated into the DSS; and over half of them stayed 6 months or longer. In 2008; IDPs aged 15.49 years died at higher rates than regular residents of the DSS (relative risk; RR: 1.34; 95confidence interval; CI: 1.004.1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged . 5 years (53) than among regular DSS residents (25.29) (P 0.001). Internally displaced children 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95CI: 2.44.3.58). Conclusion HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps; particularly if afflicted with HIV infection or other chronic conditions

A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia

Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana; Uganda; South Africa and Zambia. The findings are part of a 5 year study; the Mental Health and Poverty Project; which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. Method: The World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan; and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Results: Child and adolescent mental health (CAMH) - related legislation; policies; services; programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Conclusion: Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives; and a greater investment in CAMH. Clear policy directions; priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth; parents and local organizations to promote CAMH