Desenvolvimento de aplicativo para higiene do sono em adultos / Development of an application for sleep hygiene in adults / Desarrollo de una aplicación para la higiene del sueño en adultos

Introdução: Diferentes condições clínicas podem afetar a quantidade e a qualidade do sono. As medidas de higiene do sono interferem diretamente na qualidade deste. Elas podem ser propagadas à população por meio de aplicativos. Objetivo: Desenvolver, avaliar e disponibilizar um aplicativo que contemple as medidas de higiene do sono e que seja capaz de gerar mudança e verificar a ocorrência de sonolência diurna excessiva. Metodologia: O aplicativo "Somnum" foi desenvolvido e 26 fonoaudiólogos certificados em Sono pela Associação Brasileira do Sono foram convidados a avaliar usando o questionário Emory e outro questionário elaborado pelas autoras. Após, 38 estudantes usaram o aplicativo e responderam antes e depois do uso o Índice de Qualidade do Sono de Pittsburgh e a Escala de Epworth. Resultados: Após seu desenvolvimento, o aplicativo foi avaliado por 4 fonoaudiólogas que contribuíram com suas sugestões e 38 universitários participaram respondendo os questionários, sendo que 6 deles participaram antes e após o uso do aplicativo. Sobre o Índice de qualidade de sono de Pittsburgh, foi observado na análise estatística, comparando o antes e após o uso do aplicativo, melhora da qualidade de sono (p=0,04). No que se refere ao questionário Epworth, foi verificado na situação após o uso do aplicativo "Somnum", que não houve diferença significativa. Conclusão: Após o uso do aplicativo, verificou-se possível melhora na qualidade de sono. Houve ocorrência de sonolência diurna excessiva. (AU)

Introduction: Different clinical conditions can affect the quantity and quality of sleep. Sleep hygiene measures directly affect the quality of sleep. They can be disseminated to the population by means of applications. Objective: To develop, evaluate and make available an application that approach sleep hygiene and that is able to generate changes and verify the occurrence of excessive daytime sleepiness. Methodology: The application "Somnum" was developed and 26 speech therapists certified in sleep by the Brazilian Sleep Association were invited to evaluate it using the Emory questionnaire and another questionnaire developed by the authors. Afterwards, 38 students used the application and answered before and after the use the Pittsburgh Sleep Quality Index and the Epworth Scale. Results: After its development, the app was evaluated by 4 speech therapists who contributed with their suggestions, and 38 university students participated by answering the questionnaires, 6 of them before and after the use of the application. In the Pittsburgh Sleep Quality Index, it was observed in the statistical analysis, comparing before and after using the application, improvement in sleep quality (p=0.04). In the Epworth questionnaire, it was verified in the situation after using the "Somnum" application, that there was not significant difference. Conclusion: After using the application, there was a possible improvement in sleep quality. There was occurrence of excessive daytime sleepiness. (AU)

Introducción: Diferentes condiciones clínicas pueden afectar a la cantidad y calidad del sueño. Las medidas de higiene del sueño afectan directamente a la calidad del mismo. Pueden propagarse a la población mediante aplicaciones. Objetivo: Desarrollar, evaluar y poner a disposición una aplicación que incluya medidas de higiene del sueño y que sea capaz de generar cambios y verificar la aparición de somnolencia diurna excesiva. Metodología: Se desarrolló la aplicación "Somnum" y se invitó a 26 fonoaudiólogos certificados en soeño por la Asociación Brasileña del Sonido a evaluarla utilizando el cuestionario Emory y otro cuestionario elaborado por los autores. Posteriormente, 38 estudiantes utilizaron la aplicación y respondieron antes y después del uso de la misma al Índice de Calidad del Sueño de Pittsburgh y a la Escala de Epworth. Resultados: Tras su desarrollo, la aplicación fue evaluada por 4 fonoaudiólogos que aportaron sus sugerencias y 38 estudiantes universitarios participaron respondiendo a los cuestionarios, 6 de ellos antes y después del uso de la aplicación. Sobre el Índice de Calidad del Sueño de Pittsburgh, se observó en el análisis estadístico, comparando antes y después del uso de la aplicación, mejoría en la calidad del sueño (p=0,04). Con respecto al cuestionario de Epworth, se verificó en la situación posterior al uso de la aplicación "Somnum", que no hubo diferencia significativa. Conclusión:Después de usar la aplicación, hubo uma posible mejora em la calidad del sueño. Hubo ocurrencia de somnolencia diurna excesiva. (AU)

Wait and consult times for primary healthcare services in central Mozambique: a time-motion study.

BACKGROUND: We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. DESIGN: We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. RESULTS: Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. DISCUSSION: The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.

Assessment of linkages from HIV testing to enrolment and retention in HIV care in Central Mozambique.

INTRODUCTION: Effectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care. However, the measurement of both has been challenging in these settings. This study aimed to assess enrolment and retention in HIV care (pre-ART and ART) among HIV-positive adults in Central Mozambique, including identification of barriers and facilitators. METHODS: We assessed linkages to and retention in HIV care using a mixed quantitative and qualitative approach in six districts of Manica and Sofala provinces. We analyzed routine district and health facility monthly reports and HIV care registries from April 2012 to March 2013 and used single imputation and trimmed means to adjust for missing values. In eight health facilities in the same districts and period, we assessed retention in HIV care among 795 randomly selected adult patient charts (15 years and older). We also conducted 25 focus group discussions and 53 in-depth interviews with HIV-positive adults, healthcare providers and community members to identify facilitators and barriers to enrolment and retention in HIV care. RESULTS: Overall, 46% of the monthly HIV testing reports expected at the district level were missing, compared to 6.4% of the pre-ART registry reports. After adjustment for missing values, we estimated that the aggregate numbers of adults registered in pre-ART was 75% of the number of persons tested HIV-positive in the six districts. In the eight health facilities, 40% of the patient charts for adults enrolled in pre-ART and 44% in ART were missing. Of those on ART for whom charts were found, retention in treatment within 90 and 60 days prior to the study team visit was 34 and 25%, respectively. Combining these multiple data sources, the overall estimated retention was 18% in our sample. Individual-level factors were perceived to be key influences to enrolment in HIV care, while health facility and structural-level factors were perceived to be key influences of retention. CONCLUSIONS: Efforts to increase linkages to and retention in HIV care should address individual, health facility, and structural-level factors in Central Mozambique. However, their outcomes cannot be reliably assessed without improving the quality of routine health information systems.

Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009-2012.

BACKGROUND: We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors. METHODS: Monthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010-2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants. RESULTS: Median concordance increased from 56.3% during the baseline period (2009-2010) to 87.5% during 2012-2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010-2011 and 1.6% (CI: 0.89, 2.2) per month from 2011-2012. No significant improvements were observed from 2009-2010 (during baseline period) or 2012-2013. Facilities with more technical staff (aß: 0.71; CI: 0.14, 1.3), more first antenatal care visits (aß: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aß: -0.94; CI: -1.7, -0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: -64.8 -38.6) lower data concordance. CONCLUSIONS: A data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.

Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009­2012

We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors. Monthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010­2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants. Median concordance increased from 56.3% during the baseline period (2009­2010) to 87.5% during 2012­2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010­2011 and 1.6% (CI: 0.89, 2.2) per month from 2011­2012. No significant improvements were observed from 2009­2010 (during baseline period) or 2012­2013. Facilities with more technical staff (aß: 0.71; CI: 0.14, 1.3), more firstantenatal care visits (aß: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aß: -0.94; CI: −1.7, −0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: −64.8 -38.6) lower data concordance. A data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.

Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013.

OBJECTIVES: To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. METHODS: Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. RESULTS: Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. CONCLUSIONS: Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs.