Community health workers' experiences of supervision by nurses at clinics in Limpopo Province

Background: Supervision of community health workers (CHWs) is considered, among others, a strategy to achieve universal healthcare globally. In South Africa, it is incorporated in the ward-based primary healthcare (PHC) outreach teams' policy and strategy, a national health insurance policy component. Supervision of CHWs by nurses in the policy is considered a measure to facilitate PHC service provision to communities. However, CHWs experienced varying levels of supervision from nurses and other workers globally and in South Africa. Aim: This study explored and described the experiences of CHWs about supervision received from nurses at PHC facilities in Limpopo Province. Setting: Participants were drawn from seven PHC facilities in Polokwane and Lepelle-Nkumpi subdistricts of the Capricorn District. Methods: A qualitative exploratory-descriptive and contextual study design was employed. Participants were selected utilising a purposive sampling method. Semi-structured interviews were conducted to collect data. Data were analysed according to themes and their associated categories. Measures to ensure rigour and ethical principles were applied. Results: Two main themes emerged: positive supervision experienced by CHWs and supervision challenges experienced by CHWs. Conclusion: The varying experiences of CHWs about supervision from nurses emerged and reflected the need for functioning supervision mechanisms. Contribution: The experiences of CHWs indicated inconsistent delivery of supervision by nurses in PHC facilities. The findings highlighted the need for effective supervision measures that are vital for the success of the CHW supervision programme.

Preparedness of Healthcare Facilities of Manipur in the Management of Noncommunicable Diseases: A Cross-Sectional Study

Background: India is experiencing a rapid health transition with a rising burden of noncommunicable diseases (NCDs), causing significant morbidity and mortality. Cost?effective interventions for comprehensive NCD management can only be designed after assessing the readiness of various health facilities. Objectives: This study aimed to assess the preparedness of healthcare facilities of Manipur in the management of NCDs and to assess the knowledge of doctors regarding NCDs. Methods: A cross?sectional study was conducted in 21 public healthcare facilities in seven districts of Manipur during October 2021. Readiness of these facilities was assessed through observation and interview of doctors and nurses using a checklist adapted from the WHO Package of Essential NCDs. Knowledge of 153 doctors was also assessed using a self?administered, structured questionnaire. Data were entered in SPSS?26 and expressed using descriptive statistics. Results: General readiness index of primary health centers(PHCs), community health centers(CHCs), district hospitals(DHs), and tertiary care centers(TCCs) was 47%, 66.3%, 73.2%, and 70%, respectively. CHCs were ready in the domains of patient care services (80%), human resources (75%), and advocacy (91.7%). DHs and TCCs were ready in terms of patient care services, human resources, record maintenance, referral system, and advocacy. PHCs were not ready in any of the nine domains. Majority of the doctors (88%) had inadequate knowledge regarding NCDs. Conclusion: PHCs and CHCs were not adequately prepared, but DHs and TCCs were ready to manage NCDs. More than four?fifth of the doctors had inadequate knowledge. Strengthening PHCs and CHCs and training of healthcare workers are needed for integrated NCD management.

Reasons behind declining of cases during the COVID-19 wavelets in Pakistan: public healthcare system or government smart lockdown policy? / Razões do declínio de casos durante as ondas de COVID-19 no Paquistão: sistema público de saúde ou política de bloqueio inteligente do governo?

Abstract The latest statistics show that COVID-19 is still very active, and cases are on the rise across various countries and regions. On the other hand, statistics from Pakistan show a declining trend, especially during the first wave of the COVID-19 pandemic. To understand this declining trend and answering our established question, "What are the reasons behind the decline of the COVID-19 cases in Pakistan - public healthcare facilities or government smart lockdown policy?" narrative literature-based evidence collected from government official websites, reports and also Google Scholar. Our findings suggest that the government's innovative smart lockdown strategy and its execution at the right time with the consensus of all stakeholders accompanied with the observing of COVID-19 standard operation procedures resulted in controlling the pandemic. Effective smart lockdown policy allows the government to identify shortcomings of and improve the capabilities of healthcare for the continuation of balanced socio-economic activities to avoid future spread-out of the pandemic in the time of crisis under national and World Health Organization guidelines.

Resumo As últimas estatísticas mostram que a COVID-19 ainda está muito ativa, e os casos estão aumentaando em vários países e regiões. Por outro lado, as estatísticas do Paquistão mostram uma tendência decrescente, em especial durante a primeira onda da pandemia de COVID-19. Para compreender esta tendência decrescente e responder à nossa pergunta estabelecida, "Quais são as razões por detrás do declínio do caso COVID-19 no Paquistão - instalações públicas de saúde ou política de encerramento inteligente do governo?" - foi compilada evidências narrativas baseadas em literatura recolhida de websites oficiais do governo, relatórios e também no Google Scholar. As nossas conclusões sugerem que a estratégia inovadora de encerramento inteligente do governo e a sua execução no momento certo, com o consenso de todos os interessados acompanhados pela observação dos procedimentos de operação padrão da COVID-19, resultou no controle da pandemia. Uma política eficaz de encerramento inteligente permite ao governo identificar deficiências e melhorar as capacidades dos cuidados de saúde para a continuidade de atividades socioeconômicas equilibradas, a fim de evitar a propagação futura da pandemia em tempo de crise, sob as diretrizes nacionais e da Organização Mundial de Saúde.

Maternal Satisfaction Towards Intrapartum Care of Designated Healthcare Facilities and Its Associated Factors Among Postnatal Women Attending Klinik Kesihatan Salak

@#Introduction: The World Health Organization recommends evaluation of maternal satisfaction to improve quality of health care during childbirth. Dissatisfaction may lead to undesired outcomes such as unassisted homebirth and delay in seeking treatment. Determining the maternal satisfaction level and its associated factors may help to improve health care services and prevent negative implications to both mothers and infants. This study aimed to determine the maternal satisfaction towards intrapartum care of designated healthcare facilities and its associated factors among postnatal women. Methods: This was a cross-sectional study of postnatal women attended Klinik Kesihatan Salak from December 2017 to February 2018. Systematic random sampling with the ratio of 1:3 was applied to the eligible respondents. A self-administered questionnaire that include respondent’s socio-demographic characteristics and a validated 14-items Maternal Satisfaction with Hospital-based Intrapartum Care Scale was used. Data was analyzed using SPSS 23. Results: 274 respondents were recruited in this study. Overall, only 21.2% of respondents were satisfied with the intrapartum care given. The level of satisfaction was highest in interpersonal care domain (36.1%), followed by physical birth environment (34.3%) and the least satisfied was information and decision making domain (27.7%). Binary logistic regression showed that maternal satisfaction was significantly associated with place of birth (AOR (95% CI): 0.046 (0.183, 0.984)) and labour complications (AOR (95% CI): 3.387 (1.345, 8.528)). Conclusion: The overall maternal satisfaction towards intrapartum care was low and the information and decision-making domain appeared to be the least satisfied. Maternal satisfaction was associated with place of birth and labour complications. Therefore, health care providers should emphasize and improve the quality of services especially for this domain and to consider factor that contribute to dissatisfaction towards the intrapartum care.

Factors Affecting Blood Pressure Control among Hypertensive Patients Attending Primary Healthcare Facilities in Western Jamaica / Factores que afectan el control de la presión arterial entre los pacientes hipertensos que asisten a centros de atención primaria en Jamaica occidental

ABSTRACT Objective: To identify patient-related factors that act as barriers to hypertension control. Methods: A cross-sectional study of 365 patients who were diagnosed with primary hypertension and attended primary healthcare facilities in western Jamaica was carried out. A pretested questionnaire was administered, and the patients ' blood pressure and body mass index were taken and calculated. Inferential statistics were used to interpret the data. Chi-square and Fischer's exact tests were used to analyse the differences in dichotomous variables. A p-value of ≤ 0.05 was regarded as statistically significant. Two focus group discussions and 10 in-depth interviews provided qualitative data. Results: Of the 365 participants, only 30.1% had blood pressure readings within normal limits. The blood pressure was statistically significantly higher in those who last smoked under one year (p = 0.018), those who consumed alcohol (p = 0.021), those who reported high stress levels (p = 0.020) and those with a weak support system (p = 0.012; Spearman's rank correlation coefficient = 0.131). Knowledge deficit was also statistically significant where 55.1% believed that hypertension could be cured or were unsure and 27.5% denied personal responsibility in achieving control. Patients who had been diagnosed 11 years or more were more likely to be uncontrolled (p = 0.010). Medication adherence (p = 0.056), alternative medicine (p = 0.476), diet (p = 0.108), exercise (p = 0.568) and obesity (p = 0.941) showed no statistically significant relationship. Conclusion: Smoking, alcohol consumption, stress, level of awareness and support system were significant modifiable determinants of blood pressure control. Clinicians often place much emphasis on medication adherence, diet and exercise. However, these modifiable contributing factors are often overlooked in the management of hypertension. Addressing these issues could result in a significant improvement in blood pressure control.

RESUMEN Objetivo: Identificar factores relacionados con el paciente que actúan como barreras al control de la hipertensión. Métodos: Se realizó un estudio transversal de 365 pacientes que fueron diagnosticados con hipertensión primaria y atendidos en centros de salud de atención primaria en el occidente de Jamaica. Se administró un cuestionario previamente probado, y se tomaron y calcularon los índices de presión arterial e índice de masa corporal de los pacientes. Se utilizaron estadísticas inferenciales para interpretar los datos. Se utilizaron las pruebas exactas de Chi-cuadrado y Fischer para analizar las diferencias en las variables dicotómicas. Un valor p de ≤ 0.05 se consideró estadísticamente significativo. Dos discusiones de grupos focales y 10 entrevistas en profundidad proporcionaron datos cualitativos. Resultados: De los 365 participantes, sólo el 30.1% tuvo lecturas de presión arterial dentro de los límites normales. La presión arterial fue estadísticamente significativamente mayor en aquellos que fumaron por última vez menos de un año (p = 0.018), los que consumían alcohol (p = 0.021), los que reportaron altos niveles de estrés (p = 0.020), y aquellos con un sistema de apoyo débil (p = 0.012; coeficiente de correlación de rango de Spearman = 0.131). El déficit de conocimiento también fue estadísticamente significativo en el 55.1% que creía que la hipertensión podía ser curada o no estaba seguro, y en el 27.5% que negaba la responsabilidad personal de lograr el control. Los pacientes que habían sido diagnosticados 11 años o más, eran más propensos a ser descontrolados (p = 0.010). El cumplimiento de la medicación (p = 0.056), la medicina alternativa (p = 0.476), la dieta (p= 0.108), los ejercicios (p = 0.568) y la obesidad (p = 0.941) no mostraron ninguna relación estadísticamente significativa. Conclusión: El tabaquismo, el consumo de alcohol, el estrés, el nivel de conciencia, y el sistema de apoyo, fueron factores determinantes modificables significativos del control de la presión alterial. Los clínicos a menudo ponen mucho énfasis en el cumplimiento de la medicación, la dieta y el ejercicio. Sin embargo, los mencionados factores contribuyentes modificables a menudo se pasan por alto en el tratamiento de la hipertensión. Abordar estos problemas podría traer consigo una mejoría significativa en el control de la presión arterial.

Management of multi-drug resistant organisms in healthcare settings

Antimicrobial resistance is an important global threat to public health. Hospitals, in particular, are increasingly faced with the emergence and transmission of multidrug-resistant organisms (MDROs). In hospitals, MDROs are transmitted via the hands of healthcare workers, from the contaminated environment, or directly from person to person. Although the transmission of MDROs is frequently recognized in acute care facilities, all healthcare settings are affected by MDROs. Given the evolving epidemiology of MDROs and the complexity of managing them across heterogeneous healthcare settings, multimodal strategies should be adopted to control and prevent the transmission of MDROs. It is fundamental to ensure adherence to evidence-based healthcare-associated infection prevention strategies, including hand hygiene, antimicrobial stewardship, and adequate environmental cleaning, and to ensure the reliable performance of basic infection prevention practices known to mitigate the transmission of MDROs. Healthcare-associated infections and MDROs should be surveilled in a standardized manner in order to detect outbreaks and newly introduced MDROs in healthcare facilities. When epidemiologically important pathogens newly emerge in healthcare facilities or to control outbreaks of specific pathogens, active surveillance cultures combined with preemptive isolation and contact precautions can also be implemented. Healthcare facilities should make sure that appropriate strategies are fully implemented, regularly evaluated for effectiveness, and adjusted as needed. Successful prevention and control of MDROs can be accomplished by administrative leadership, financial and human resource commitments by individual healthcare facilities, and continuous governmental efforts to make resources available for infection prevention and control.

La investigación en instituciones de salud de mediana y alta complejidad del Valle de Aburrá, 2011 / Research in Mid and High Complexity Healthcare Facilities in the Aburra Valley, 2011 / A pesquisa em institutes de saúde de mediana e alta complexidade do Valle de Aburrá, 2011

Objetivo: identificar el nivel de conocimiento de los empleados acerca de las políticas de investigación en las instituciones de salud de mediana y alta complejidad en el Valle de Aburrá, Colombia. Metodología: investigación de corte transversal, con aplicación de encuestas a 224 empleados en las instituciones prestadoras de servicios salud de alta (52) y mediana complejidad (322), públicas y privadas en el 2011. Resultados: en referencia al conocimiento de la existencia de políticas de investigación, se encontró que este es mayor en los empleados de las instituciones de alta complejidad (p=0,000). Más del 70% de los empleados encuestados manifestaron su interés en trabajar en proyectos de investigación. Conclusión: las instituciones de salud de alta complejidad y públicas tuvieron más desarrollos en investigación y se percibió gran interés por la investigación en los empleados del sector salud, con independencia del nivel de complejidad, del tipo de institución y del nivel de formación.

Objective: identifying the knowledge level of the employees regarding the research policies of mid and high complexity healthcare facilities in the Aburra Valley, Colombia. Methodology: cross-section research, with surveys for 224 employees of the healthcare providing institutions of high (52) and mid (322) complexity, both public and private, in 2011. Results: regarding the knowledge about the existence of research policies, we found that it is higher in the employees of high complexity institutions (p = 0.000). Over 70% of the employees surveyed showed their interest in working on research projects. Conclusion: public high complexity healthcare facilities showed more developments on research and we found great interest of the employees of the health sector on research, regardless of the complexity level, the type of facility, and education level.

Objetivo: identificar o nivel de conhecimento dos empregados sobre as políticas de pesquisa nas instituicoes de saúde de mediana e alta complexidade no Valle de Aburrá, Colombia. Metodologia: pesquisa de corte transversal, com aplicação de inquéritos a 224 empregados de instituicoes prestadoras de servicos de saúde de alta (52) e mediana complexidade (322), públicas e privadas no ano 2011. Resultados: no que diz respeito do conhecimento sobre a existencia de políticas de pesquisa, encontrou-se que é maior em empregados de instituicoes de alta complexidade (p = 0,000). Mais de 70 % dos empregados indagados manifestaram interesse por trabalhar em projetos de pesquisa. Conclusão: as instituicoes de saúde de alta complexidade públicas tiveram maior desenvolvimento de pesquisa e percebeu-se grande interesse dos empregados do sector saúde pela pesquisa, com independencia do nível de complexidade, do tipo de instituicao e do nível de formação.

Apontamentos para a arquitetura hospitalar no Brasil: entre o tradicional e o moderno / Notes on hospital architecture in Brazil: between the traditional and the modern

Aponta desafios para aprofundar a relação nem sempre evidente entre história da assistência em saúde e arquitetura, expressa de forma mais clara na construção dos espaços para tratamento médico, sobretudo os hospitais e os sanatórios. Estamos diante da constituição de um campo de conhecimento pouco explorado, que vem animando pesquisadores das ciências humanas e sociais aplicadas no Brasil, sobretudo nas últimas décadas.

The relationship between the history of health assistance and architecture is not always obvious. The article points to some challenges in investigating this relation, which is most readily visible in the construction of medical facilities, especially hospitals and sanitariums. In Brazil, this fledgling field has begun drawing the attention of researchers from the applied human and social sciences, especially in more recent decades.

Vulnerabilidade no manejo dos resíduos de serviços de saúde de João Pessoa (PB, Brasil) / Vulnerability of management of waste from health services in João Pessoa, State of Paraíba (Brazil)

Observa-se na academia a discussão sobre os resíduos sólidos urbanos (RSU), sendo os oriundos de serviços de saúde (RSS) parte integrante dos RSU, não necessariamente pela quantidade gerada, mas pelo potencial de risco que afeta à saúde coletiva e ambiental. Objetivou-se verificar a vulnerabilidade do manejo dos RSS, nos estabelecimentos de atenção primária, secundária e terciária de João Pessoa - PB. Foi uma pesquisa quantitativa, exploratória e descritiva do manejo dos RSS, tendo como instrumentos de coleta de dados checklist e avaliação analítica da vulnerabilidade do manejo dos RSS. Percebeu-se que 21,05 por cento dos estabelecimentos não realizam segregação, 26,34 por cento não padronizam os sacos plásticos e 47,37 por cento dos trabalhadores responsáveis pela coleta não possuem treinamento para o manuseio dos RSS. Conclui-se que a vulnerabilidade do manejo dos RSS de João Pessoa - PB foi significativo 48,02 por cento, podendo contribuir para a deterioração da saúde ambiental e coletiva, acarretando problema de saúde pública.

The discussion in the academy on solid urban waste residues (UWR) is analyzed, with health service waste (HSW) being an integral part of UWR, not necessarily in terms of the amount generated, but due to the risk potential to collective and environmental health. The scope of the study was to verify the vulnerability of UWR handling in primary, secondary and tertiary healthcare units in João Pessoa in the state of Paraíba. This involved a quantitative, exploratory and descriptive investigation of the handling of UWR, using a checklist and analytical evaluation of the vulnerability of HSW handling for data collection. It was detected that 21.05 percent of the establishments failed to separate hazardous waste, 26.34 percent did not standardize plastic disposal bags, and 47.37 percent of the workers responsible for collection were not trained to handle HSW. It was concluded that the vulnerability of HSW handling in João Pessoa in the order of 48.02 percent, was significant, potentially contributing to the deterioration of environmental and collective health and leading to a public health problem.