A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War.

Importance: Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. Objective: To analyze hospital services in Ukraine during the period before and after the Russian invasion. Design, Setting, and Participants: Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Main Outcomes and Measures: Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Results: Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. Conclusions and Relevance: The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.

Malaria epidemics in India: Role of climatic condition and control measures.

Malaria is a major public health problem in India, which is the second most populous country in the world. This study aimed to investigate the impact of climatic parameters and malaria control efforts implemented by the Indian national malaria control program on malaria epidemics between January of 2009 and December of 2015. A chi-squared test was used to study the correlation of all implemented control methods with occurrence of epidemics within 30, 45, 60 and 90 days and in the same district, 50, 100 and 200 km distance radiuses. The effect of each control method on probability of epidemics was also measured, and the effects of district population, season, and incidence of malaria parasite types were evaluated using logistic regression models. Fever survey was found to be effective for decreasing the odds of epidemics within 45, 60 and 90 days in 100 km. Anti-larval activity was also effective within 30, 45 and 60 days in 200 km. Winter had negative effects on odds ratio while summer and fall were more likely to trigger epidemics. These results contribute to understanding the role of climate variability and control efforts performed in India.