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1.
HIV Med ; 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39107614

RESUMO

BACKGROUND: The introduction of universal test and treat (UTT) strategy has demonstrated a reduction in attrition in some low-resource settings. UTT was introduced in Ethiopia in 2016. However, there is a paucity of information regarding the magnitude and predictors of attrition from HIV treatment in Ethiopia. This study aims to assess the incidence and predictors of attrition from HIV treatment among adults living with HIV (PLHIV) in high-caseload facilities following the implementation of universal test and treat strategy in Ethiopia from March 2019 to June 2020. METHODS: A prospective cohort of individuals in HIV care from 39 high-caseload facilities in Oromia, Amhara, Tigray, Addis Ababa and Dire Dawa regions of Ethiopia was conducted for 12 months. Participants were adults aged 15 year and older who were first testers recruited for 3 months from March to June 2019. Subsequent follow-up was for 12 months, with data collected on sociodemographic and clinical conditions at baseline, 6 and 12 months and attrition at 6 and 12 months. We defined attrition as discontinuation from follow-up care due to loss to follow-up, dropout or death. Data were collected using Open Data Kit at field level and aggregated centrally. Kaplan-Meier survival analysis was employed to assess survival probability to the time of attrition from treatment. The Cox proportional hazards regression model was used to measure association of baseline predictor variables with the proportion of antiretroviral therapy (ART) patients retained in ART during the follow up period. RESULTS: The overall incidence rate for attrition from HIV treatment among the study participants during 12 months of follow-up was 5.02 cases per 1000 person-weeks [95% confidence interval (CI): 4.44-5.68 per 1000 person-weeks]. Study participants from health facilities in Oromia and Addis Ababa/Dire Dawa had 68% and 51% higher risk of attrition from HIV treatment compared with participants from the Amhara region, respectively [adjusted hazard ratio (AHR) = 1.68, 95% CI: 1.22-2.32 and AHR = 1.51, 95% CI: 1.05-2.17, respectively]. Participants who did not have a child had a 44% higher risk of attrition compared with those who had a child (AHR = 1.44, 95% CI: 1.12-1.85). Individuals who did not own mobile phone had a 37% higher risk of attrition than those who owned a mobile phone (AHR = 1.37, 95% CI: 1.02-1.83). Ambulatory/bedridden functional status at the time of diagnosis had a 44% higher risk of attrition compared with participants with a working functional status (AHR = 1.44, 95% CI: 1.08-1.92) at any time during the follow-up period. CONCLUSION: The overall incidence of attrition among people living with HIV enrolled into HIV treatment was not as high as what was reported by other studies. Independent predictors of attrition were administrative regions in Ethiopia where health facilities are located, not having a child, not owning a mobile phone and being ambulatory/bedridden functional status at the time of diagnosis. Concerted efforts should be taken to reduce the magnitude of attrition from HIV treatment and address its drivers.

2.
BJOG ; 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38960882

RESUMO

OBJECTIVE: Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP). DESIGN: Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020. SETTING: Fifty-four referral level facilities in Nigeria. POPULATION: Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery. METHODS: Descriptive statistics and multilevel mixed-effects logistic regression models. MAIN OUTCOME MEASURES: Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes. RESULTS: Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82-2.12; p < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06-1.32; p = 0.002), primary level of education (OR 1.20, 95% CI 1.03-1.4; p < 0.002), nulliparity (OR 1.21, 95% CI 1.12-1.31; p < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21-1.52; p < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15-1.38; p < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13-1.31; p < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders. CONCLUSIONS: Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are poor with about a quarter developing complications and about 1 in 10 having stillbirths.

3.
Pharmacy (Basel) ; 12(4)2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39051396

RESUMO

The effective management of the medicine supply chain is crucial for ensuring the availability of essential medicines and supplies in public health facilities. This study aimed to determine the utilization of the electronic logistic management information system (e-LMIS) in public health facilities and its implications for the medicine supply chain. A mixed methods approach, combining both quantitative and qualitative data collection methods, was used. The study included 106 healthcare providers from 35 public health facilities in Singida District. Six key informants were interviewed using a qualitative method. Of the 106 participants, 62.3% said they were somehow competent in e-LMIS utilization. In in-depth interviews, respondents underscored the system's utility for tracking stock levels, procurements, and managing orders. Staff shortages and a lack of customized training were mentioned as major challenges hindering efficiency in managing drug supplies. This study highlighted the positive impact of e-LMIS on various aspects of the medicine supply chain, including the timely submission of orders and enhanced inventory management. Sustained management support and the regular utilization of the e-LMIS system are crucial for building and maintaining competence among healthcare providers, thereby optimizing the medicine supply chain and ultimately improving healthcare delivery.

4.
BMC Health Serv Res ; 24(1): 850, 2024 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-39061057

RESUMO

BACKGROUND: The burden of neglected tropical diseases (NTDs), HIV/AIDS, tuberculosis, and malaria pose significant public health challenges in Ethiopia. This study aimed to the explore service availability and readiness for NTD care among Ethiopian health facilities treating tuberculosis (TB), HIV/AIDS, and/or malaria. METHODS: This study utilized secondary data from the Ethiopian Service Provision Assessment 2021-22 survey. The availability of services was calculated as the percentage of HIV/AIDS, tuberculosis, or malaria facilities providing NTD services. Facilities were considered highly prepared to manage any type of NTD if they scored at least half (> 50%) of the tracer items listed in each of the three domains (staff training and guidelines, equipment, and essential medicines). Descriptive statistics and logistic regression models were employed to present the study findings and analyze factors influencing facility readiness, respectively. RESULTS: Out of 403 health facilities providing NTD care nationally, 179, 183, and 197 also offer TB, HIV/AIDS, and malaria services, respectively. The majority of TB (90.1%), HIV/AIDS (89.6%), and malaria (90.9%) facilities offer soil-transmitted helminth services, followed by trachoma (range 87-90%). The percentages of the aforementioned facilities with at least one trained staff member for any type of NTD were 87.2%, 88.4%, and 82.1%, respectively. The percentage of facilities with guidelines for any type of NTD was relatively low (range 3.7-4.1%). Mebendazole was the most widely available essential medicine, ranging from 69 to 70%. The overall readiness analysis indicated that none of the included facilities (TB = 11.9%; HIV/AIDS = 11.6%; and malaria = 10.6%) were ready to offer NTD care. Specifically, a higher level of readiness was observed only in the domain of medicines across these facilities. Hospitals had better readiness to offer NTD care than did health centers and clinics. Furthermore, a significant associations were observed between facility readiness and factors such as facility type, region, presence of routine management meetings, types of NTD services provided, and fixed costs for services. CONCLUSIONS: Ethiopian health facilities treating TB, HIV/AIDS, and malaria had an unsatisfactory overall service availability and a lack of readiness to provide NTD care. Given the existing epidemiological risks and high burden of TB, HIV/AIDS, malaria, and NTDs in Ethiopia, there is an urgent need to consider preparing and implementing a collaborative infectious disease care plan to integrate NTD services in these facilities.


Assuntos
Instalações de Saúde , Acessibilidade aos Serviços de Saúde , Malária , Doenças Negligenciadas , Etiópia/epidemiologia , Humanos , Doenças Negligenciadas/terapia , Malária/terapia , Malária/tratamento farmacológico , Acessibilidade aos Serviços de Saúde/organização & administração , Tuberculose/terapia , Tuberculose/tratamento farmacológico , Infecções por HIV/terapia , Infecções por HIV/epidemiologia , Medicina Tropical
5.
BMC Emerg Med ; 24(1): 131, 2024 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-39075340

RESUMO

BACKGROUND: The process of transferring patients from small rural primary care facilities to referral facilities impacts the quality of care and effectiveness of the referral healthcare system. The study aimed to develop and evaluate the psychometric properties of a scale measuring requirements for effective rural emergency transfer. METHODS: An exploratory sequential design was utilized to develop a scale designed to measure requirements for effective emergency transport. Phase one included a qualitative, interview study with 26 nursing transport providers. These transcripts were coded, and items developed for the proposed scale. Phase two included a content validity review by these 16 transport providers of the domains and items developed. Phase three included development and evaluation of psychometric properties of a scale designed to measure requirements for effective emergency transport. This scale was then tested initially with 84 items and later reduced to a final set of 58 items after completion by 302 transport nurses. The final scale demonstrated three factors (technology & tools; knowledge & skills; and organization). Each factor and the total score reported excellent scale reliability. RESULTS: The initial item pool consisted of 84 items, generated, and synthesized from an extensive literature review and the qualitative descriptive study exploring nurses' experiences in rural emergency patient transportation. A two-round modified Delphi method with experts generated a scale consisting of 58 items. A cross-sectional study design was used with 302 nurses in rural clinics and health in four rural health districts. A categorical principal components analysis identified three components explaining 63.35% of the total variance. The three factors, technology, tools, personal knowledge and skills, and organization, accounted for 27.32%, 18.15 and 17.88% of the total variance, respectively. The reliability of the three factors, as determined by the Categorical Principal Component Analysis (CATPCA)'s default calculation of the Cronbach Alpha, was 0.960, 0.946, and 0.956, respectively. The RET Cronbach alpha was 0.980. CONCLUSIONS: The study offers a three-factor scale to measure the effectiveness of emergency patient transport in rural facilities to better understand and improve care during emergency patient transport.


Assuntos
Transferência de Pacientes , Psicometria , Serviços de Saúde Rural , Humanos , Transferência de Pacientes/normas , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/normas , Reprodutibilidade dos Testes , Feminino , Masculino , Transporte de Pacientes , Adulto , Inquéritos e Questionários/normas , Pesquisa Qualitativa , Pessoa de Meia-Idade
6.
Healthcare (Basel) ; 12(14)2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-39057538

RESUMO

Developing and implementing an epidemiological surveillance plan was necessary during the COVID-19 pandemic to ensure safe dental practice. This was due to the high risk faced by this occupational group during the COVID-19 pandemic. This study aimed to determine the factors associated with COVID-19 diagnosis in a Peruvian dental school's integrated teaching and care service. A cross-sectional study was conducted with a population made up of the records of students, teachers, and administrative personnel in a COVID-19 epidemiological surveillance plan of a dental school during the years 2021 to 2022. The year 2022 was positively associated with a positive diagnosis of COVID-19 (aPR: 1.51; 95% CI: 1.10-2.07; p = 0.010) and not having had contact with a patient with COVID-19 was negatively associated with being diagnosed with that disease (aPR: 0.20; 95% CI: 0.14-0.27; p < 0.001). In conclusion, 2022 was positively associated with having a positive COVID-19 diagnosis. In addition, not having had contact with a COVID-19 patient was negatively associated with the disease diagnosis and with the development of moderate to severe COVID-19.

7.
J Nepal Health Res Counc ; 22(1): 142-149, 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-39080951

RESUMO

BACKGROUND: NCDs prevalence and associated risk factors impacts on the burden of disease and premature mortality. Effective NCD service delivery requires well equipped facilities with trained providers and resources. Evaluating readiness and its determinant is crucial for enhancing NCD management. The study examines readiness in primary health care facilities for managing non-communicable disease in Syangja district. METHODS: A cross-sectional research was conducted among 117 Primary health care facility health workers in Nepal's Syangja District. The data was collected through face-to-face interviews using modified WHO-SARA tool. The chi-square test was used to evaluate the relationship between NCD readiness and its associated factors and multivariable logistic regression was utilized to determine the strength of the correlation. RESULTS: Only 6 percent of the healthcare facilities in Syangja district had developed the system for readiness against non-communicable diseases. The mean percentage scores for service-specific domains ranged from 40% to 58%, indicating variations in readiness across different domains mainly contributed by basic amenities and training. Approximately 80.3% of health facilities received support from the local government, while equipment or commodities support was provided to the third- quarter of the health facilities. CONCLUSION: Total service readiness was very low in the diagnostic and medicine facilities of Syangja. It demonstrates that there is a discrepancy between the present situation of the incremental trend of NCDs and the related level of service preparedness in primary health care settings. The development of the service readiness mechanism is imperative considering the increasing prevalence of non-communicable diseases in Syangja.


Assuntos
Doenças não Transmissíveis , Atenção Primária à Saúde , Humanos , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/terapia , Nepal/epidemiologia , Atenção Primária à Saúde/organização & administração , Estudos Transversais , Feminino , Masculino , Adulto , Instalações de Saúde/estatística & dados numéricos , Instalações de Saúde/normas , Entrevistas como Assunto
8.
Lancet Reg Health Southeast Asia ; 27: 100436, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39049977

RESUMO

Background: Ensuring equitable physical access to SARS-CoV-2 testing has proven to be crucial for controlling the COVID-19 epidemic, especially in countries like Nepal with its challenging terrain. During the second wave of the pandemic in May 2021, there was immense pressure to expand the laboratory network in Nepal to ensure calibration of epidemic response. The expansion led to an increase in the number of testing facilities from 69 laboratories in May 2021 to 89 laboratories by November 2021. We assessed the equity of physical access to COVID-19 testing facilities in Nepal during 2021. Furthermore, we investigated the potential of mathematical optimisation in improving accessibility to COVID-19 testing facilities. Methods: Based on up-to-date publicly available data sets and on the COVID-19-related daily reports published by Nepal's Ministry of Health and Population from May 1 to November 15, 2021, we measured the disparities in geographical accessibility to COVID-19 testing across Nepal at a resolution of 1 km2. In addition, we proposed an optimisation model to prescribe the best possible locations to set up testing laboratories maximizing access, and tested its potential impact in Nepal. Findings: The analysis identified vulnerable districts where, despite ramping up efforts, physical accessibility to testing facilities remains low under two modes of travel-walking and motorized driving. Both geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation were available to everyone, the population coverage within 60 min of any testing facility (public and private) would be close to threefold the coverage for pedestrians within the same hour: 61.4% motorised against 22.2% pedestrian access within the hour, considering the whole population of Nepal. Very low accessibility was found in most areas except those with private test centres concentrated in the capital city of Kathmandu. The hypothetical use of mathematical optimisation to select 20 laboratories to add to the original 69 could have improved access from the observed 61.4% offered by the laboratories operating in November to 71.4%, if those 20 could be chosen optimally from all existing healthcare facilities in Nepal. In mountainous terrain, accessibility is very low and could not be improved, even considering all existing healthcare facilities as potential testing locations. Interpretation: The findings related to geographical accessibility to COVID-19 testing facilities should provide valuable information for health-related planning in Nepal, especially in emergencies where data might be limited and decisions time-sensitive. The potential use of publicly available data and mathematical optimisation could be considered in the future. Funding: WHO Special Programme for Research and Training in Tropical Diseases (TDR).

9.
Artigo em Alemão | MEDLINE | ID: mdl-39017943

RESUMO

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.

10.
Artigo em Inglês | MEDLINE | ID: mdl-39023718

RESUMO

INTRODUCTION: Cholera remains a substantial public health challenge in Somalia. Ongoing droughts in the country have caused significant outbreaks which have negatively affected the lives of many individuals and overwhelmed health facilities. We aimed to estimate the costs associated with cholera cases for households and health facilities in Somalia. METHODS: This cost-of-illness study was conducted in five cholera treatment centres in Somalia and 400 patients treated in these facilities. Data collection took place during October and November 2023. Given that a significant portion of the patients were children, we interviewed their caregivers to gather cost data. We interviewed staff at the centres and the patients. The data obtained from the household questionnaire covered direct (medical and non-medical) and indirect (lost wages) costs, while direct costs were estimated for the health facility (personnel salaries, drugs and consumables used to treat a patient, and utility expenses). All costs were calculated in US dollars (USD), using 2023 as the base year for the estimation. RESULTS: The average total cost of a cholera episode for a household was US$ 33.94 (2023 USD), with 50.4% (US$ 17.12) being direct costs and 49.6% (US$ 16.82) indirect costs. The average total cost for a health facility to treat an episode of cholera was US$ 82.65. The overall average cost to households and health facilities was US$ 116.59. The average length of stay for a patient was 3.08 days. In the households, patients aged 41 years and older incurred the highest mean total cost (US$ 73.90) while patients younger than 5 years had the lowest cost (US$ 21.02). Additionally, 61.8% of households had to use family savings to cover the cost of the cholera episode, while 14.5% had to borrow money. Most patients (71.8%) were younger than 16 years- 45.3% were 5 years or younger- and 94.0% had never received a cholera vaccine. CONCLUSION: Our study suggests that preventing one cholera episode in Somalia could avert substantial losses for both the households and cholera treatment centres. The findings shed light on the expenses associated with cholera that extend beyond healthcare, including substantial direct and indirect costs borne by households. Preventing cholera cases could lead to a decrease in this economic burden, consequently our study supports the need for preventive measures.

11.
Healthcare (Basel) ; 12(13)2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38998835

RESUMO

BACKGROUND: Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. METHODS: This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. RESULTS: Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. CONCLUSIONS: This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings.

12.
Niger Med J ; 65(3): 332-343, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39022567

RESUMO

Background: Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria. Methods: Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23. Results: Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team. Conclusion: Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

14.
BMC Public Health ; 24(1): 1718, 2024 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-38937707

RESUMO

Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men's uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25-39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6-10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25-39 years. Additionally, preferences were influenced by individual's disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.


Assuntos
Circuncisão Masculina , Grupos Focais , Preferência do Paciente , Pesquisa Qualitativa , Humanos , Masculino , Circuncisão Masculina/estatística & dados numéricos , Circuncisão Masculina/psicologia , Quênia , Adulto , Preferência do Paciente/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Acessibilidade aos Serviços de Saúde
15.
Reprod Health ; 21(1): 73, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822390

RESUMO

BACKGROUND: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. METHODS: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. RESULTS: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. CONCLUSION: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.


Assuntos
Cuidado Pré-Natal , Humanos , Feminino , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Etiópia , Adulto , Estudos Retrospectivos , Seguimentos , Adulto Jovem , Gestantes/psicologia , Adolescente , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Fatores de Tempo
16.
Cureus ; 16(5): e60095, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38860108

RESUMO

INTRODUCTION:  Older adults are at increased risk of psychotic symptoms and even more at risk of medication nonadherence due to various factors specific to their age including memory impairment. This study aimed to examine the availability of long-acting injectable antipsychotics (LAIs) in US mental health (MH) facilities that serve older adults. METHODS: This study includes 1,216 MH facilities, using the 2022 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Descriptive statistics were used to evaluate the availability of LAIs in US MHs that provide services to older adults while logistic regression was used to compare facilities that offer the services compared to those that do not. RESULTS: Of the total facilities included, 420 (35%) and 58 (4.8%) offered at least one LAI and all LAIs, respectively. Hospital-based facilities compared to community-based facilities, facilities that provided only MH services compared to those providing SU and MH services, facilities that offer special Alzheimer's programs compared to those that do not, and facilities in Midwest states compared to those in East South Central, New England, and Mountain regions of the US were more likely to offer at least one LAI. Facilities that offer special services for veterans were less likely to have all LAIs examined. Only 43% of the facilities were certified by the Joint Commission. CONCLUSION: Less than half of US MH facilities that serve older adults have at least one LAI service despite the usefulness of these medications in the studied population.

17.
Chemosphere ; 362: 142615, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38880262

RESUMO

The present study examines indoor air pollution in health facilities, focusing on compounds from various sources, such as industrial products, healthcare activities and building materials. It assesses chemical and microbiological concentrations in two public hospitals, two public healthcare centres, and one public health laboratory in Spain. Measurements included indoor air quality, microbiological contaminants, ambient parameters and non-target analysis across ten different locations. Outdoor air quality was also assessed in the surroundings of the hospitals. The results showed that around 350 substances were tentatively identified at a high confidence level, with over 50 % of compounds classified as of high toxicological risk. Three indoor and 26 outdoor compounds were fully confirmed with standards. These confirmed substances were linked to medical, industrial and agricultural activities. Indoor Air Quality (IAQ) results revealed that CO, CO2, formaldehyde (HCHO), O3 and total volatile organic compounds (TVOCs) showed average values above the recommended guideline levels in at least one of the evaluated locations. Moreover, maximum concentrations detected for CO, HCHO, O3 and TVOCs in hospitals surpassed those previously reported in the literature. SARS-CoV-2 was detected in three air environments, corresponding to COVID-19 patient areas. Fungi and bacteria concentrations were acceptable in all assessed locations, identifying different fungi genera, such as Penicillium, Cladosporium, Aspergillus, Alternaria and Botrytis.

18.
Heliyon ; 10(10): e30738, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38765034

RESUMO

Controlling the microbial load in the environment is crucial to prevent the spread of organisms. The continuous spread of nosocomial infections in hospital facilities and the emergence of the coronavirus (COVID-19) highlighted the importance of disinfection processes in health safety. This work aimed to evaluate the effectiveness of LED-based disinfection lamps on bacteria from the ESKAPEE group and virus phage in vitro inactivation to be applied in hospital environments and health facilities disinfection. This study evaluated the effect of different UV wavelengths (275 nm, 280 nm (UVC), 310 nm (UVB) and 340 nm (UVA)) on the disinfection process of various microbial indicators including E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499. Exposure time (5 min-30 min), exposure distance (0.25 m and 0.5 m) and surface materials (glass, steel, and polished wood) were evaluated on the disinfection efficiency. Furthermore, the study determined the recovery capacity of each species after UV damage. UVC-LED lamps could inactivate 99.99 % of microbial indicators after 20 min exposures at a 0.5 m distance. The exposure time needed to completely inactivate E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499 can be decreased by reducing the exposure distance. UVB-LED and UVA-LED lamps were not able to promote a log reduction of 4 and were not effective on B. subtilis or bacteriophage lambda DSM 4499 inactivation. Thus, only UVC-LED lamps were tested on the decontamination of different surface materials, which was successful. P. aeruginosa showed the ability to recover from UV damage, but its inactivation rate remains 99.99 %, and spores from B. subtilis were not completely inactivated. Nevertheless, the inactivation rate of these indicators remained at 99.99 % with 24 h incubation after UVC irradiation. UVC-LED lamps emitting 280 nm were the most indicated to disinfect surfaces from microorganisms usually found in hospital environments.

19.
Artigo em Inglês | MEDLINE | ID: mdl-38775901

RESUMO

BACKGROUND: Enhanced adherence counseling refers to the counseling intervention for Human Immunodeficiency Virus (HIV) patients with an elevated viral load result, a viral load of > 1000 copies/ml, on a routine or need-based viral load test. The Federal Ministry of Health, Ethiopia, has launched routine viral load testing and enhanced adherence counseling since 2016 for high-viral load people living with HIV, which is applicable throughout the country for all health facilities providing HIV care and treatment. Our study aimed to assess viral load suppression after enhanced adherence counseling and its predictors among high viral load people living with HIV who were on antiretroviral therapy. METHOD: We conducted a health facility-based retrospective follow-up study among 352 HIV-infected high-viral load people enrolled in enhanced adherence counseling from July 2018 to June 2021 in Nekemte town public health facilities. Cox proportional hazard analysis was used to identify independent predictors. RESULTS: The overall 65.1% of 352 persons on antiretroviral treatment achieved HIV viral load suppression after enhanced adherence counseling, (15.01 per 100 person months (95% CI13.02-16.99)). The median time to viral load suppression was 5 months. Age ≥ 15 years (AHR = 1.99, 95% CI: 1.11-3.57), no history of opportunistic infection (AHR = 2.01, 95% CI: 1.18-3.41), and not using substances (AHR = 2.48, 95% CI: 1.19-5.14) were more likely to have viral load suppressed, while having an initial viral load count greater than 50,000 RNA copies/ml (AHR = 0.56, 95% CI: 0.37-0.85) were less likely to have viral load suppressed after enhanced adherence counseling. CONCLUSION: Age, history of opportunistic infections, substance use, and an initial viral load count > 50,000 RNA copies/mL were significant predictors of viral load suppression. Enrolling all high-viral-load patients in enhanced adherence counseling is recommended for viral load suppression.

20.
Midwifery ; 135: 104024, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38733754

RESUMO

BACKGROUND: Research in low- and middle-income countries has shown that maternal mortality is directly related to inadequate or absent obstetric (OB) triage systems. Standard triage systems and knowledge on triaging for obstetric emergencies are often absent or lacking in most healthcare systems in Liberia. OBJECTIVE: The objective of this research was to address the third delay defined as receiving adequate, quality care when a facility is reached by increasing knowledge through the establishment of a midwife-led, hospital-based OB triage system to stratify care based on risk and imminence of birth and to improve timely assessment at two district referral hospitals. METHODS: A quasi-experimental study design using a pre/post survey was employed for a midwife-led OB triage training course. Using a train-the-trainer model, five midwives were trained as champions, who in turn trained an additional 62 providers. Test results were analyzed with the R statistical software using paired sample t-test and descriptive statistics. RESULTS: Pretest results revealed a knowledge and practice gap among OB providers on key components of the standard triage package. However, post-test mean scores were significantly higher (M = 79.6, SD = 2.32) than pre-test mean scores (M = 59.0, SD = 2.30) for participants following a 2-day training (p = <0.001). DISCUSSION: Following a structured OB triage training, participants showed significant improvement in post-test OB triage scores. CONCLUSION: Standard OB triage protocols incorporated into the policies and procedures of obstetric wards have the potential to improve knowledge and practice, addressing the third delay and reducing preventable, obstetrics-related deaths.


Assuntos
Tocologia , Triagem , Humanos , Triagem/métodos , Triagem/normas , Feminino , Gravidez , Adulto , Tocologia/educação , Tocologia/normas , Tocologia/métodos , Inquéritos e Questionários , Libéria
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