Linking household and facility data for better coverage measures in reproductive, maternal, newborn, and child health care: systematic review.

BACKGROUND: Currently many measures of intervention coverage obtained from household surveys do not measure actual health intervention/service delivery, resulting in a need for linking reports of care-seeking with assessments of the service environment in order to improve measurements. This systematic review aims to identify evidence of different methods used to link household surveys and service provision assessments, with a focus on reproductive, maternal, newborn and child health care, in low- and middle-income countries. METHODS: Using pre-defined search terms, articles published in peer-reviewed journals and the grey literature after 1990 were identified, their reference lists scanned and linking methods synthesized. FINDINGS: A total of 59 articles and conference presentations were carefully reviewed and categorized into two groups based on the linking method used: 1) indirect/ecological linking that included studies in which health care-seeking behavior was linked to all or the nearest facilities or providers of certain types within a geographical area, and 2) direct linking/exact matching where individuals were linked with the exact provider or facility where they sought care. The former approach was employed in 51 of 59 included studies, and was particularly common among studies that were based on independent sources of household and facility data that were nationally representative. Only eight of the 59 reviewed studies employed direct linking methods, which were typically done at the sub-national level (eg, district level) and often in rural areas, where the number of providers was more limited compared to urban areas. CONCLUSIONS: Different linking methods have been reported in the literature, each category has its own set of advantages and limitations, in terms of both methodology and practicality for scale-up. Future studies that link household and provider/facility data should also take into account factors such as sources of data, the timing of surveys, the temporality of data points, the type of services and interventions, and the scale of the study in order to produce valid and reliable results.

Healthcare workers' challenges in the implementation of tuberculosis infection prevention and control measures in Mozambique.

OBJECTIVE: Healthcare Workers (HCWs) have a higher frequency of TB exposure than the general population and have therefore an occupational TB risk that infection prevention and control (IPC) measures aim to reduce. HCWs are crucial in the implementation of these measures. The objective of the study was to investigate Mozambican HCWs' perceptions of their occupational TB risk and the measures they report using to reduce this risk. In addition, we explored the challenges HCWs encounter while using these TBIPC measures. METHODS: Focus group discussion. Analysis according content method. PARTICIPANTS: Four categories of HCWs: auxiliary workers, medical (doctors and clinical officers), nurses and TB program staff. RESULTS: HCWs are aware of their occupational TB risk and use various measures to reduce their risk of infection. HCWs find it challenging to employ measures that minimize such risks and a lack of clear guidelines contributes to these challenges. HCWs' and patient behavior further complicate the use of TBIPC measures. CONCLUSION: HCWs in Mozambique perceive a high occupational risk of TB infection. They report several challenges using measures to reduce this risk such as shortage of material, lack of clear guidelines, insufficient motivation and inadequate training. Robust training with motivational approaches, alongside supervision and support for HCWs could improve implementation of TBIPC measures. Healthcare management should address the areas for improvement that are beyond the individual HCW's control.

A pandemia pelo SARS-CoV-2 em um hospital de universitário na Amazônia

Nos últimos anos, a emergência e reemergência de doenças infecciosas reforçaram muitas questões sobre a importância do papel da vigilância epidemiológica. Em 31 de dezembro 2019, a Organização Mundial da Saúde (OMS) foi notificada sobre a ocorrência de um surto de 27 casos de pneumonia de etiologia desconhecida, na cidade de Wuhan, província de Hubei, na China. Considerando a importância da atuação da vigilância epidemiológica na prevenção e controle da infecção o presente projeto se demostra a necessidade de compartilhar os resultados e dificuldades encontradas pela Vigilância Epidemiológica no enfrentamento à pandemia pelo SARS-CoV-2 em um hospital público universitário e a descrição dos aspectos clínico-epidemiológicos da evolução da pandemia em um hospital universitário do Pará, no período de março a outubro de 2020. Os resultados do presente estudo foi agrupada em cinco categorias. A classificação epidemiológica final para os casos investigados de Covid-19 foi: Confirmado laboratorial em 52,8% dos casos, Confirmado clínico epidemiológico em 0,12% dos casos e Descartado em 47,06%; Os métodos laboratoriais diagnósticos utilizados foram: O teste rápido em 85,2%, seguido pelo RT-PCR, responsável por 14,6% e a sorologia em 0,1% (1/899) dos casos; O sexo mais acometido foi o feminino e a média de faixa etária foi de 44 anos; A principal síndrome clínica notificada foi a síndrome gripal em 83 % dos casos e a SRAG em 17%; Foi observada significância estatística na evolução dos casos no desfecho óbito, em relação a faixa etária, a passagem por unidade crítica, a admissão hospitalar em necessidade de ventilação mecânica e na presença de fatores de risco como hipertensão arterial, doença renal crônica e neoplasias

Perfil da Infecção Hospitalar em um Hospital Universitário / Nosocomial Infection Profile at an University Hospital

Estudo epidemiológico, retrospectivo, documental, realizado em hospital universitário de Fortaleza-CE. Teve por objetivos verificar taxa de prevalência de infecção hospitalar (IH), tipos de infecções, patógenos e seu perfil de sensibilidade aos antimicrobianos. Foram analisadas 512 fichas de notificação de IH ocorridas ao longo de 2007. A taxa de IH anual média foi de 8,2%. As IH reuniram 149 (29,1%) registros de pneumonias, 136 (26,6%) infecções de corrente sangüínea, 87 (17%) infecções do trato urinário, 57 (11,1%) infecções de catéter central, 47 (9,2%) infecções de sítio cirúrgico. Os principais agentes foram: Klebsiella pneumoniae (22%), Staphylococcus aureus (20%), Pseudomonas aeruginosa (14%), Acinetobacter sp (13%), Escherichia coli (10%), Enterobacter sp (9%) e Candida sp.(9%). O perfil de sensibilidade dos dois patógenos predominantes foi: Klebsiella pneumoniae (mais de 50% de sensibilidade ao meropenem, imipenem, gentamicina, amicacina e piperacilina mais tazobactam); Staphylococcus aureus (resistência a eritromicina (66,0%), oxacilina (77,3%), penicilina (84,9%)).

This is a retrospective epidemiological documental study carried out at university hospital in Fortaleza, Ceará, Northeasten Brazil. Its main aim was to verify the prevalence rate of nosocomial infections, their types, causative pathogens, and profile of sensitivity of these pathogens to antibiotics. We analyzed 512 nosocomial infection notification forms which occurred throughout 2007. The average annual prevalence rate of nosocomial infection was 8.2%. The total number of nosocomial infections included 149 (29.1%) records of pneumonia, 136 (26.6%) bloodstream infections, 87(17%) urinary tract infections, 57 (11.1%) central catheter infections, and 47 ( 9.2%) surgical site infections. Major microorganisms encountered in these infections were as follows: Klebsiella pneumoniae (22%), Staphylococcus aureus (20%), Pseudomonas aeruginosa (14%), Acinetobacter sp (13%), Escherichia coli (10%), Enterobacter sp (9%) and Candida sp. (9%). The antibiotic sensitivity profile of the two predominant pathogens included: Klebsiella pneumoniae (over 50% sensitivity to meropenem, imipenem, gentamicin, amikacin, piperacillin, and tazobactam), Staphylococcus aureus (resistant to erythromycin (66.0%), to oxacillin (77, 3%), and to penicillin (84.9%)).

Estudio epidemiológico, retrospectivo, documental, realizado en hospital universitario de Fortaleza-CE-Brasil. Tuvo por objetivo verificar tasa de prevalencia de infección hospitalaria (IH), tipos de infecciones, patógenos y su perfil de sensibilidad a los antibióticos. Se analizaron 512 fichas de notificación de IH producidas a lo largo de 2007. La tasa de prevalência media anual de IH fue de 8,2%. Las IH reunieron 149 (29,1%) registros de neumonía, 136 (26,6%) infecciones del torrente sanguíneo, 87 (17%), infecciones del tracto urinario, 57 (11,1%) infecciones de cateter central, 47 (9,2%) infecciones de sitio quirúrgico. Los principales agentes fueron: Klebsiella pneumoniae (22%), Staphylococcus aureus (20%), Pseudomonas aeruginosa (14%), Acinetobacter sp (13%), Escherichia coli (10%), Enterobacter sp (9%) y Candida sp. (9%). El perfil de sensibilidad de los dos patógenos predominantes fue: Klebsiella pneumoniae (más de 50% de sensibilidad a meropenem, imipenem, gentamicina, amikacina y piperacilina más tazobactam); Staphylococcus aureus (resistencia a eritromicina (66,0%), oxacilina (77, 3%), penicilina (84,9%)).