District health information system 2 data utilization among health professionals in Amara region private hospitals, Ethiopia.

Background: Globally, health information systems have been improved by District Health Information System Version 2 (DHIS2), which promotes consistency and integrity in collecting data, processing, and utilization. This success has been attributed to its user-friendly interface and incorporation of advanced data analysis and validation features. Objective: This study aimed to assess DHIS2 data utilization among health professionals working at private hospitals in the Amara region. Methods: An Institution-based cross-sectional study design was conducted from 9 May to 30 June 2022. A simple random sampling technique was used to select participants, with a total of 395 health professionals participating. Data was collected using a self-administered paper-based questionnaire. Data entry was performed using the Kobo Collect tool, and data analysis was conducted using STATA version 14.0. Bivariable and multivariable logistic regression analyses were used and p < .05 with a 95% CI was considered to measure statistically significant variables. Result: Out of 395 participants, about 37.72% of the participants had good DHIS2 data utilization. Had good data analysis skills (adjusted odds ratio (AOR) = 6.5, 95% CI [3.1-13.8]), regular supportive supervision and feedback (AOR = 5.2, 95% CI [2.8-9.5]), monthly salary > 5000 ETB (AOR = 2.0, 95% CI [1.1-3.7]), ease of use (AOR = 5.4, 95% CI [2.8-10.2]), and district health information system training (AOR = 4.2, 95% CI [2.2-7.3]) were enabling factors for utilization of DHIS2 data. Conclusion: Private healthcare providers had limited utilization of DHIS2 data. It is highly recommended to provide DHIS2 training, supervision, and feedback focused on private health facilities. Additionally, enhancing data analysis skills and prioritizing ease of use are crucial to improving DHIS2 data utilization.

Obstetric outcomes among rural parturients across US urban and rural hospitals.

INTRODUCTION: The objective of this study is to evaluate severe maternal morbidity (SMM) of rural parturients delivering at rural compared to urban hospitals in the US. METHODS: We identified patients aged 18-40 years in a multi-institutional claims database who lived in a rural ZIP code and delivered at a rural or urban hospital between October-December of 2015 and October-December of 2022. The primary outcome was SMM, and the secondary outcome was SMM exclusive of blood transfusions. We combined exact ZIP code matching and propensity score matching to compare SMM risk among patients living in the same rural community and delivering in urban as compared to rural hospitals. RESULTS: A total of 214 296 patients from 571 ZIP codes were identified, including 47% delivering at rural facilities and 53% delivering at urban facilities. The SMM rate was 1.1% (0.3% excluding blood transfusions). After matching, urban versus rural delivery was associated with increased odds of SMM other than blood transfusion (odds ratio 2.44; 95% confidence interval 1.81-3.28), but was not associated with differences in risk of any SMM. CONCLUSION: There was no evidence of reduced SMM for rural patients delivering at an urban rather than a rural hospital. SMM exclusive of blood transfusions was increased for rural patients delivering at urban hospitals after matching on ZIP code and predictors of urban hospital delivery. Our findings undermine the assumption that delivery at a rural facility has inherently greater risks relative to delivery at an urban facility. As some health systems face challenges to maintain rural labor and delivery units, patient safety must be considered if confronted with the possibility of unit or hospital closures.

Arthroplasty at Very High Altitude with Restricted Resources: Our Experience and Review of Literature.

Introduction: Patients living in high altitudes are often deprived of total knee arthroplasty (TKA) due to logistic reasons, economic, and social challenges in performing surgical procedures for management of knee pain. Surgical procedures in high-altitude dwellers have associated risk of deep venous thrombosis/pulmonary embolism (DVT/PE). In patients undergoing these procedures at lower altitudes, return to high altitudes can cause high-altitude pulmonary edema (HAPE). We share our experience of performing TKA in high-altitude dwellers by setting up a surgical camp at 11,000 feet. Methods: A retrospective assessment of patients undergoing total knee arthroplasty at a camp set up at 11,000 feet between 2014 and 2020 was undertaken. Follow-up data of patients which included clinical assessment by the Knee Society Score (KSS) and complications like DVT, infection, residual deformity, etc. were included in the study. Radiographic evaluation to look for evidence of implant loosening was also inculcated. Results: 132 patients (202 knee joints in 50 male and 82 female patients) underwent TKA during annual camps. The average follow-up of patients was 60 months. Mean pre-operative KSS was 38, which was increased to 83 at 1-year follow-up post-surgery. There was no evidence of DVT or superficial or deep infection in any patient in the post-operative period. Conclusion: With this study, we want to highlight that total knee arthroplasty can be safely performed at high altitudes and remote areas with limited health facilities. We believe it is a safer and more convenient prospect for the residents of high-altitude regions. Level of evidence: III.

The nexus between geographical distance and institutional delivery trends in Ethiopia: evidence from nationwide surveys.

Background: Giving birth in a healthcare facility with the guidance of skilled healthcare providers allows access to necessary medical interventions. Ethiopia has implemented several strategies to enhance institutional delivery and decrease maternal mortality; however, the rate of institutional delivery remains low. This study examines the role of distance to healthcare institutions on institutional delivery in Ethiopia, and how this has changed over time. Method: This study used data from two rounds of the Ethiopian Demographic and Health Survey (2011 and 2016), a spatial database detailing the locations of healthcare facilities, and Ethiopian road network data. The sample included 22,881 women who delivered within the 5 years preceding each survey and lived in 1,295 villages. Bivariate and multivariable logistic regression analyses were used to investigate how the distance to health facilities and other potential determinants influenced institutional delivery trends. Results: The rate of institutional deliveries in Ethiopia has increased from 10% in 2011 to 26% in 2016. Likewise, the average transportation distance to health facilities has decreased from 22.4 km in 2011 to 20.2 km in 2016 at the national level. Furthermore, a one-kilometer increase in the distance to the nearest health facility was associated with a 1% decrease in the likelihood of delivering at a health facility in 2016 (odds ratio (OR) = 0.99, 95% CI [0.98-0.99], p < 0.05). Additionally, mothers who are more educated, have completed more antenatal care visits, live in wealthier households in more urban areas, and cohabit with more educated husbands are more likely to deliver at healthcare facilities. These variables showed consistent relevance in both survey rounds, suggesting that key determinants remained largely unchanged throughout the study period. Conclusion: The impact of distance from health facilities on institutional delivery in Ethiopia remains evident, although its influence is relatively modest. The other factors, including education, antenatal care, socioeconomic status, urban residence, and partner education, remained consistent between the two surveys. These determinants have consistently influenced institutional delivery, highlighting the importance of a comprehensive approach that addresses both access to and socioeconomic factors to improve maternal and infant health across the country.

Level of readiness of employees of Systems Plus College Foundation (SPCF) on Disaster Risk-Reduction Management (DRRM).

OBJECTIVE: To determine the level of readiness on disaster risk-reduction management among employees of an educational institution. METHODS: The descriptive, evaluative study was conducted from March to April 2022 at 6 branches of Systems Plus College Foundation, Philippines, in Balibago, Rizal, Miranda, San Fernando, Caloocan and Cubao after approval from the ethics review committee of the Our Lady of Fatima University, Philippines, and comprised employees who were associated with the college for at least 6 months. Data was collected using Google Forms, and a validated tool was used to assess the disaster risk-reduction management readiness. The responses were categorised into 5 groups, ranging from 'very much ready' to 'not ready'. Gathered data was analysed by using SPSS version 20. Mean results were derived and presented with standard deviation. RESULTS: The responses suggested moderate readiness regarding structural safety codes 3.02±0.98, non-structural safety codes 3.02±1.04, availability of emergency supplies and equipment 2.84±1.09, and servicing and maintenance 2.85±1.03. CONCLUSIONS: Increasing the level of readiness related to disaster risk-reduction management must be given priority to ensure the safety of the employees in a higher education institution.

Resource shortage in public health facilities and private pharmacy practices in Odisha, India.

In low-and-middle-income countries (LMICs), private pharmacies play a crucial role in the supply of medicines and the provision of healthcare. However, they also engage in poor practices including the improper sale of medicines and caregiving beyond their legal scope. Addressing the deficiencies of private pharmacies can increase their potential contribution towards enhancing universal health coverage. Therefore, it is important to identify the determinants of their performance. The existing literature has mostly focused on pharmacy-level factors and their regulatory environment, ignoring the market in which they operate, particularly their relationship to existing public sector provision. In this study, we fill the gap in the literature by examining the relationship between the practices of private pharmacies and resource shortages in nearby public health facilities in Odisha, India. This is possible due to three novel primary datasets with detailed information on private pharmacies and different levels of public healthcare facilities, including their geospatial coordinates. We find that when public healthcare facilities experience shortages of healthcare workers and essential medicines, private pharmacies step in to fill the gaps created by adjusting the type and amount of care provision and medicine dispensing services they provide. Moreover, the relationship depends on their location, with public facilities and private pharmacies in rural areas performing substitutive caregiving roles, while they are complementary in urban areas. This study highlights how policies aimed at addressing resource shortages in public health facilities can generate dynamic responses from private pharmacies, highlighting the need for thorough scrutiny of the interaction between public healthcare facilities and private pharmacies in LMICs.

Person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional quantitative study of client experiences.

Introduction: Ethiopia has made remarkable progress in expanding access to and provision of comprehensive abortion care. However, complications due to unsafe abortion persist. As efforts to increase quality of comprehensive abortion care continue, evaluating service quality is critical. Although "women-centered" abortion care is a central component of Ethiopia's technical guidelines for safe abortion, research has mostly focused on access to care, availability of services, and meeting clinical criteria, rather than examining service quality from abortion clients' perspectives. This study assesses the quality of comprehensive abortion care (CAC) in public health facilities, from clients' perspectives, in four regions of Ethiopia to examine how person-centered care differs based on facility and service characteristics. Methods: We conducted 1,870 client exit surveys in 2018 using structured questionnaires with women who received induced abortion or postabortion care services from 76 public health facilities across four regions: Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and People's. We operationalized person-centered care by mapping 30 indicators of quality to five of the six domains in the Person-Centered Care Framework for Reproductive Health Equity developed by Sudhinaraset and colleagues (2017): dignity & respect; autonomy; communication & supportive care; trust, privacy, and confidentiality; and health facility environment. We calculated descriptive, bivariate, and multivariable statistics to examine associations between service characteristics and person-centered care. Results: CAC clients reported high levels of person-centered care, with exceptionally positive experiences for outcomes in the dignity and respect and trust, privacy, and confidentiality domains. However, there was notable room for improving client experiences across three domains: autonomy, communication and supportive care, and health facility environment. Client-reported quality outcomes differed significantly by diagnosis (induced or postabortion care), region, health facility type, and procedure type. Clients in Amhara, clients at tertiary and primary hospitals, and clients who received postabortion care reported lower levels of person-centered care. Discussion: The positive experiences reported by comprehensive abortion care clients bolster evidence of the impact of the Ethiopian government's strategy to increase abortion access in the public health sector. However, notable disparities exist for key subgroups, particularly those seeking postabortion care and people visiting tertiary and primary hospitals. Quality improvement efforts should concentrate on improving abortion clients' autonomy, communication and supportive care, and the health facility environment. The Ethiopian Ministry of Health and its partners must dedicate resources to improve postabortion care quality, integration of reproductive health services within CAC, and pain management for MA clients as vital interventions.

Inventory Management Performance for Tracer Medicines in Public Health Facilities of Southwest Shewa Zone Oromia Region, Ethiopia: A mixed study.

Introduction: Tracer medicines are medicines that must be available in sufficient quantities at all times to satisfy the priority health care needs of the population. Inventory mismanagement of these medicines poses significant challenges to public health systems, especially in countries like Ethiopia, where access to healthcare services is already limited. Objective: This study aims to assess inventory management performance for tracer medicines at public health facilities of the southwest Shewa zone, Oromia region, Ethiopia. Method: Concurrent triangulation mixed-method study was conducted from 1 to 30 June 2022. The quantitative data were collected using interviewer-administered semistructured questionnaires and observational checklists. The qualitative data were gathered through in-depth interviews with key informants. The quantitative data were analyzed using the SPSS version 26 and Excel spreadsheet version 16. We calculated the stock-out rate, inventory accuracy rate, percentage of facilities that fulfill appropriate storage conditions, percentage of facilities that submitted reports on time, and received the exact quantity of drugs they ordered. Qualitative data were analyzed manually using the thematic content analysis technique. Results: The inventory accuracy rate for tracer medicines was 76% for hospitals and 72.5% for health centers. The overall mean stock-out rate was 24.99%. Bin card updating practice was 93.3%, and only 25% health facilities met the acceptable storage conditions criteria. Among submitted reports, 88.8% were timely reported, 72.2% were accurate, and 75% were complete. Inventory management challenges include a shortage of supplies from the supplier and in the market, price inflation, inadequate training, lack of supportive supervision, insufficient IT and storage infrastructures, lack of communication, and budget constraints. Conclusion: From this finding, we concluded that facilities' report quality, inventory record accuracy, storage conditions, and logistics management information system needs improvements. Therefore, Ministry of Health, assessed facilities and Ethiopian pharmaceuticals Supply Services should take measures to improve them.

Community voices from modern maternal waiting home users in Zambia.

Objective: This study aimed to understand community voices on factors influencing utilisation of MMWHs in Zambia. Methods: The study employed a mixed method study design in four selected health facilities across Zambia districts between January 2021 and December 2022. Purposeful sampling was used to select study participants using MMWH registers as the sampling frame for mothers who had utilised MMWHs and their spouses. Sampling of participants through face-to-face, in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted to saturation in all targeted health facilities Data was transcribed verbatim and analysed thematically. Results: Results found that the comfortable state of the MMWHs, long distances to health facilities, fear of maternal complications, availability and positive attitudes of specialized health personnel, and the information on childcare provided were major factors. Spouses supported their partners using MMWHs due to the quality of care and the availability of modern equipment and furniture. However, some spouses indicated that utilisation of MMWHs has a bearing on a household's financial resources. Conclusion: MMWHs are a pivotal intervention in improving maternal outcomes. All health facilities had no maternal and newborn complications or deaths over the study period.

Challenges and coping strategies for providing maternal health care services among health care professionals in rural health facilities in Wolaita Zone, Southern Ethiopia: a qualitative study.

BACKGROUND: Many factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone. OBJECTIVE: To explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023. METHOD: A phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant's interview was written word for word and analyzed using ATLAS.ti 7 software. RESULT: Five main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals' personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies. CONCLUSION: Healthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women's lives matter, then this situation requires a call to action.

Incidence and predictors of attrition from HIV treatment among adults living with HIV in high-caseload facilities following implementation of universal test and treat strategy in Ethiopia: A prospective cohort study.

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.

Facilitating and limiting factors of cultural norms influencing use of maternal health services in primary health care facilities in Kogi State, Nigeria; a focused ethnographic research on Igala women.

BACKGROUND: Facilitating factors are potential factors that encourage the uptake of maternal health services, while limiting factors are those potential factors that limit women's access to maternal health services. Though cultural norms or values are significant factors that influence health-seeking behaviour, there is a limited exploration of the facilitating and limiting factors of these cultural norms and values on the use of maternal health services in primary health care facilities. AIM: To understand the facilitating and limiting factors of cultural values and norms that influence the use of maternal health services in primary healthcare facilities. METHODS: The study was conducted in two primary healthcare facilities (rural and urban) using a focused ethnographic methodology described by Roper and Shapira. The study comprised 189 hours of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, data was collected through 21 in-depth interviews, two focus group discussions comprising 13 women, and field notes. All data was analyzed using the steps described by Roper and Shapira (Ethnography in nursing research, 2000). RESULTS: Using the enabler and nurturer constructs of the relationships and the expectations domain of the PEN-3 cultural model, four themes were generated: 1, The attitude of healthcare workers and 2, Factors within primary healthcare facilities, which revealed both facilitating and limiting factors. The remaining themes, 3, The High cost of services, and 4, Contextual issues within communities revealed factors that limit access to facility care. CONCLUSION: Several facilitating and limiting factors of cultural norms and values significantly influence women's health-seeking behaviours and use of primary health facilities. Further studies are needed on approaches to harness these factors in providing holistic care tailored to communities' cultural needs. Additionally, reinvigoration and strengthening of primary health facilities in Nigeria is critical to promoting comprehensive care that could reduce maternal mortality and enhance maternal health outcomes.

"It's normal to be afraid": attacks on healthcare in Ouaka, Haute-Kotto, and Vakaga prefectures of the Central African Republic, 2016-2020.

INTRODUCTION: Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery. METHODS: We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings. RESULTS: Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support. CONCLUSION: Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR's government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.

Solid health care waste management practice in Ethiopia, a convergent mixed method study.

INTRODUCTION: Healthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods. This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town. METHOD: A mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town. RESULT: Seventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ''the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market''. The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus. CONCLUSION: Hand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.

Cost of Cholera for Households and Health Facilities, Somalia.

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.

[When should a liver disease patient be admitted to the intensive care unit?] / Wann soll ein Leberkranker auf die Intensivstation?

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.

A Culture of Early Mobilization in Adult Intensive Care Units: Perspective and Competency of Physicians.

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.

Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities.

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.

Positive Diagnosis of COVID-19 in an Integrated Teaching and Healthcare Service and Its Associated Factors.

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.

Availability and readiness of health facilities providing services for other infectious diseases to treat neglected tropical diseases in Ethiopia: implications for service integration in high burden areas.

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.