O perfil de queixas técnicas relacionadas a equipos comercializados no Brasil e o impacto na segurança do paciente / The profile of technical complaints related to infusion sets sold in Brazil and the impact on patient safety / El perfil de las quejas técnicas relacionadas con los equipos vendidos en Brasil y el impacto en la seguridad del paciente

Equipos são dispositivos médicos que, ao apresentarem desvios de qualidade, podem ocasionar agravos a elevado número de pessoas. Este estudo objetivou avaliar o perfil das notificações de queixas técnicas realizadas no Sistema Notivisa, desenvolvido pela Agência Nacional de Vigilância Sanitária, para discussão sobre o seu impacto na segurança do paciente. Por meio de metodologia quantitativa foram avaliados equipos comercializados no período de 2016 a 2017, cinco anos após a instituição da certificação metrológica compulsória. As principais queixas técnicas se referiram a problemas na integridade (82,70%): defeito mecânico, vazamentos, problemas no corta-fluxo, oclusão de fluido e descolamento, problemas na embalagem ou rotulagem (8,54%) e presença de corpo estranho e sujidades (7,97%). Tais falhas podem interferir nos procedimentos diagnósticos e/ou de tratamento, como a administração de medicamentos quimioterápicos, de antibióticos e também a realização de transfusões. Assim, a tecnovigilância é fundamental para a segurança sanitária no mercado a partir da identificação dos riscos e da possibilidade de mitigá-los, promovendo a segurança do paciente.

Infusion sets are medical devices that, when presenting quality deviations, can cause harm to a large number of people. This study aimed to evaluate the profile of technical complaint notifications made on the Notivisa System, developed by Anvisa ­ Agência Nacional de Vigilância Sanitária (National Agency for Health Surveillance), so as to discuss its impact on patient safety. By means of quantitative methodology, devices sold from 2016 to 2017 was evaluated, five years after the establishment of compulsory metrological certification. The main technical complaints referred to integrity problems (82.70%): mechanical defect, leaks, flow shutdown issues, fluid obstruction and detachment, packaging or labeling problems (8.54%) and presence of foreign bodies and dirt (7.97%). Such failures can interfere with diagnostic and/or treatment procedures such as the administration of chemotherapy drugs, antibiotics and also the transfusion process. Thus, the technovigilance is essential for health safety in the market, based on the identification of risks and the possibility of mitigating them, thus promoting the patient safety.

Los equipos son aparatos médicos quepueden resultar en daños a un gran número de personas por si acaso presentan desviaciones de calidad. El objetivo de esta investigación ha sido evaluar el perfil de notificacio-nes de quejas técnicasregistradas en el Sistema Notivisa, desarrollado por Anvisa ­ Agência Nacional de Vigilância Sanitária (Agencia Nacional de Vigilancia Sanitaria) con miras a la discusión de su impacto en la seguridad del paciente. Valiéndose de la metodología cuantitativa se evaluaron los equipos comercializadosdesde 2016 hasta 2017, que coincide con los cinco años tras la institución de la certificación metrológica obligatoria. Las principales quejas técnicas (82,70%) se refirieron a problemas de integridad: defecto me-cánico, fugas, problemas en el corta flujo oclusión y despegue de fluidos, dificultades en el embalaje o en la rotulación (8,54%) además de la presencia de cuerpo extraño y suciedades (7,97%). Dichos desperfectospueden obstaculizar los procedimientos de diagnóstico y/o de tratamiento, como la administración de fármacos quimioterapéuticos, antibióticos y también la realización de trasfusiones. De ahí que la tecnovi-gilancia sea fundamental para la vigilancia sanitaria en el mercado a partir de la identificación de riesgos sumada a la posibilidad de paliarlos, fomentando la seguridad del paciente.

Recopilación de experiencias exitosas en relación a la atención integral de salud en adolescentes y jóvenes. Documento técnico / Compilation of successful experiences in relation to comprehensive health care in adolescents and young people. Technical document

La presente publicación describe experiencias exitosas de salud en adolescentes y jóvenes ejecutadas en los establecimientos de salud y otras instituciones con el objetivo de evidenciar, documentar y dar a conocer las experiencias de trabajo que se vienen realizando en nuestro país y que contribuyen con el bienestar de la población adolescente y joven. En total se presentaron al concurso 54 experiencias, de los cuales, a través del cumplimiento de los requisitos establecidos en la base del concurso, sólo 51 experiencias cumplieron los requisitos solicitados, y a través de una rúbrica se calificó y se obtuvo 8 experiencias exitosas ganadoras: 2 experiencias en trabajo en comunidad, 1 experiencia en Talleres, 2 experiencias en trabajos con familias, 1 experiencia en docencia y 2 experiencias en paquete de atención integral de salud

Lineamientos técnicos para el funcionamiento y la atención en los hogares de espera materna / Technical guidelines for the operation and care in maternity waiting homes

Los presentes Lineamientos técnicos para el funcionamiento y la atención en los hogares de espera materna (HEM), han sido creados para brindar al personal del Sistema Nacional Integrado de Salud, las disposiciones para la atención a las mujeres en etapas de embarazo, puerperio y persona recién nacida a fin de dar cumplimiento a lo establecido en la Ley Nacer con Cariño para un Parto Respetado y un Cuidado Cariñoso y Sensible para el Recién Nacido, en adelante La Ley. Este documento permitirá generar las condiciones para que toda mujer en etapas de embarazo, puerperio y persona recién nacida, pueda tener una experiencia positiva del parto, por medio de una amplia gama de servicios, entre los cuales se encuentra la sensibilización a partir de la preparación prenatal integral, la provisión a la mujer embarazada y su familia de la información necesaria para la búsqueda de atención oportuna en los establecimientos de salud, así como conocer sus derechos y obligaciones

These Technical Guidelines for the operation and care in Maternity Waiting Homes (HEM) have been created to provide the staff of the National Integrated Health System with provisions for care for women in stages of pregnancy, puerperium and person newborn in order to comply with the provisions of the Born with Affection Law for a Respectful Childbirth and Affectionate and Sensitive Care for the Newborn, hereinafter The Law. This document will generate the conditions so that all women in stages of pregnancy, puerperium and newborn person, can have a positive experience of childbirth, through a wide range of services, among which is awareness-raising based on comprehensive prenatal preparation, provision to pregnant women and their families of the necessary information to seek timely care in health facilities, as well as to know their rights and obligations

Contigo MINSA. Boletín informativo 2022. Edición 7 / With you MINSA. Newsletter 2022. Edition 7

Desde el 27 de octubre de este año, fecha en que asumimos la gestión, también aceptamos el reto de darle a nuestro Ministerio de Salud (MINSA), un rostro humano, social e inclusivo que permita brindar un servicio digno y de calidad en cada posta, centro de salud y hospital de todo el país. Este compromiso se evidencia, también, en el avance que hemos logrado en los procesos de cambio de grupo ocupacional y de línea de carrera, nombramiento y homologación de los trabajadores de salud, pues reconocemos que la estabilidad laboral del personal es clave para brindar un mejor servicio a la población. Hemos ratificado el compromiso del sector de seguir fortaleciendo el Esquema Regular de Vacunación y contra la COVID-19, así como apoyar a los pacientes oncológicos, lo cual tenemos que abordar mediante un trabajo multisectorial, con planes multianuales para cumplir con los indicadores que hoy se ven trazados con políticas de Estado. Asimismo, conocedores de la realidad del primer nivel de atención y de los hospitales de referencia y apoyo, dotaremos a los establecimientos de salud, de equipamiento y medicamentos necesarios para cerrar las brechas existentes con énfasis en la salud preventiva y el concepto de médico de familia. Por último, reivindicamos el esfuerzo del personal de salud que estuvo en la primera línea de batalla frente a la COVID-19, reafirmando nuestro compromiso de seguir trabajando por el cumplimiento de sus derechos laborales

Compendio estadístico: Información de recursos humanos del sector salud, Perú 2013-2021 / Statistical compendium: Information on human resources in the health sector, Peru 2013-2021

La presente publicación consta de trece capítulos, que se describen a continuación: El Capítulo I proporciona información de los recursos humanos en el Sector Salud, donde se destaca la densidad de recursos humanos a nivel nacional, y la densidad de los profesionales médicos, enfermeros y obstetras por cada 10,000 habitantes; y por región. También se considera la disponibilidad de recursos humanos por cada una de las entidades del Sector. El Capítulo II presenta un panorama global de los recursos humanos en el Ministerio de Salud y los Gobiernos Regionales, segmentados por una serie de variables de interés según los departamentos; así tenemos la información de recursos humanos por género, por sedes asistenciales y administrativas, por la categoría del establecimiento, por niveles de atención, por áreas urbanas y rurales, por zonas de frontera, por establecimientos de salud en zonas alejadas, en zonas de frontera, en zonas del VRAEM según departamento, incluyendo por establecimientos de salud clasificados como estratégicos por el Ministerio de Salud. El Capítulo III detalla la información sobre recursos humanos por variables laborales y sociales, según departamento, resaltando su distribución por grupo ocupacional y género, por cargo de los profesionales de salud, por zonas urbanas y rurales, por quintiles de pobreza, por régimen y condición laboral, por establecimientos ubicados en zonas alejadas y de frontera, por establecimientos estratégicos, y en zonas del VRAEM. Los Capítulos IV y V proporcionan información respecto a la disponibilidad de médicos en el Ministerio de Salud y los Gobiernos Regionales, incluidos los médicos especialistas. Asimismo, enfatizan la información sobre el número de médicos por régimen y condición laboral, por sedes administrativas, sedes asistenciales, categoría del establecimiento, por niveles de atención, quintiles de pobreza, zonas urbanas y rurales, por zonas alejadas y de frontera, por establecimientos de salud estratégicos y los ubicados en el VRAEM. También se identifica la disponibilidad de médicos especialistas clasificados por género según especialidad, por especialidades básicas, por sedes asistenciales y sus respectivas categorías, por sedes administrativas, por niveles de atención, por quintil de pobreza, por régimen y condición laboral de cada una de las especialidades. Los Capítulos VI, VII y VIII presentan un panorama sobre la disponibilidad de enfermeros, obstetras y odontólogos en el Ministerio de Salud y los Gobiernos Regionales, clasificados según departamento, género, régimen y condición laboral, por sedes asistenciales y sus respectivas categorías, por sedes administrativas, por niveles de atención, quintiles de pobreza, distribución por zonas urbanas y rurales, por zonas de frontera, por establecimientos de salud en zonas alejadas y de frontera, por establecimientos de salud clasificados como estratégicos, y establecimientos ubicados en el VRAEM. Los Capítulos IX, X y XI detallan información sobre la disponibilidad de técnicos asistenciales en enfermería, técnicos asistenciales en general y profesionales de la salud respectivamente, del Ministerio de Salud y los Gobiernos Regionales; clasificados por departamento, género, régimen y condición laboral, por sedes asistenciales y sus respectivas categorías, por sedes administrativas, por niveles de atención, quintiles de pobreza, distribución por zonas urbanas y rurales, por zonas de frontera, por establecimientos en zonas alejadas y de frontera, por establecimientos de salud clasificados como estratégicos, y establecimientos ubicados en el VRAEM. El Capítulo XII, proporciona información sobre los profesionales que realizan el Residentado Médico en el Sector Salud, destacando la información del número de plazas, postulantes, ingresantes, y las modalidades de ingreso. El Capítulo XIII, presenta información de los profesionales de la salud que realizan el SERUMS, destacando la información de las plazas adjudicadas remuneradas para médicos, enfermeros, obstetras y odontólogos, ofertadas por cada institución del Sector Salud.

Manual de procesos y procedimientos quirúrgicos seguros / Manual of safe surgical processes and procedures

El presente manual de procesos y procedimientos, documenta las principales actividades de atención integral en procedimientos quirúrgicos seguros, como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida con enfoque de atención primaria en salud, describe el sistema de operación de los establecimientos de salud, mediante el enfoque por procesos, fomentando el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional. Establece las bases para la ejecución de los procesos y procedimientos, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas

This manual of processes and procedures documents the main activities of comprehensive care in safe surgical procedures, as part of the process of comprehensive and integrated health care to the person in the course of life with a focus on primary health care, describes the system of operation of health establishments, through a process approach, promoting organizational development and continuous improvement for the fulfillment of the institutional mission. Establishes the bases for the execution of processes and procedures, unifying content criteria that allows the systematization of activities and the definition of the methodology to carry them out

Manual de procesos y procedimientos de atención de salud integral en hospitalización / Manual of processes and procedures for comprehensive health care in hospitalization

El presente manual de procesos y procedimientos documenta las principales actividades de atención integral en hospitalización como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida con enfoque de atención primaria en salud, describe el sistema de operación de los establecimientos de salud, mediante el enfoque por procesos, fomentando el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional. Esta herramienta táctica y operativa, permite integrar las actividades y tareas de manera ágil, para el logro de la prestación de servicios con calidad de hospitalización con los diferentes niveles de atención, facilitando el cumplimiento de las normativas y lineamientos de programas especiales o por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano en salud

This manual of processes and procedures documents the main activities of comprehensive care in hospitalization as part of the process of comprehensive and integrated health care to the person in the course of life with a focus on primary health care, describes the operating system of the health establishments, through a process approach, promoting organizational development and continuous improvement for the fulfillment of the institutional mission. This tactical and operational tool allows activities and tasks to be integrated in an agile manner, in order to achieve the provision of hospitalization quality services with the different levels of care, facilitating compliance with the regulations and guidelines of special programs or by cycle of care. in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent in health more effective

Percepção dos discentes de fisioterapia acerca de doenças infectocontagiosas: uma pesquisa de campo / Perception of physical therapy students about infectious and contagious diseases: a field research

Introdução: As atividades desenvolvidas nos estabelecimentos de saúde muitas vezes constituem um risco à saúde dos profissionais e pacientes, principalmente em relação às doenças infectocontagiosas. Nesse contexto, sabe-se que os pacientes atendidos pelo profissional fisioterapeuta variam desde atletas a indivíduos imunossuprimidos, o que torna imprescindível a inserção desta temática no currículo dos estudantes. Objetivo: Investigar a percepção dos estudantes de Fisioterapia de uma universidade pública acerca de conceitos de biossegurança e algumas doenças infectocontagiosas. Métodos: Tratou-se de um estudo quali-quantitativo do tipo descritivo exploratório de caráter transversal, no qual foram aplicados questionários sobre a conduta do fisioterapeuta frente às doenças infectocontagiosas. A amostra, definida por conveniência, foi composta por 105 estudantes. Resultados: Cerca de 67,3% dos estudantes reconheceram o conceito de biossegurança. Em relação às precauções de contato, 59% dos discentes afirmaram serem necessárias em casos de escabiose, 46,7% na furunculose e 34,3 % no impetigo. Conclusão: A partir do presente estudo, foi possível concluir que apesar do elevado percentual de respostas assertivas, o aprendizado adquirido durante a formação acadêmica pode ser perdido no decorrer das práticas ocupacionais, o que demonstra a importância da educação continuada na prática clínica do profissional fisioterapeuta. (AU)

Impacto do tamanho das instituições de longa permanência na adesão às orientações de prevenção de infecções por COVID-19 / Impact of long-term care facilities' size on adherence to COVID-19' infection prevention guidance / Impacto del tamaño de las instituciones de larga estancia en la adhesión a las orientaciones de prevención de infecciones por COVID-19

Resumo Objetivo: avaliar a adesão das instituições de longa permanência brasileiras às orientações de Prevenção e Controle de Infecções da Organização Mundial da Saúde, observando a associação entre seu porte e a adesão a essas recomendações. Método: estudo transversal realizado com gestores de estabelecimentos. Os autores desenvolveram um questionário de 20 itens, com base nessas orientações, e um escore global de adesão, com base na adesão a essas recomendações. A adesão foi classificada como (1) excelente para aquelas que atenderam ≥14 de 20 recomendações, (2) bom para 10 a 13 itens e (3) baixo para aquelas com menos de dez itens. O tamanho das instalações foi classificado como pequeno, médio e grande, de acordo com uma análise de cluster em duas etapas. Estatística descritiva e teste de qui-quadrado foram utilizados com nível de significância de 5%. Resultados: das 362 instituições incluídas, 308 (85,1%) aderiram a 14 ou mais recomendações. Em relação ao seu tamanho, a adesão à triagem de sintomas de COVID-19 dos visitantes (p=0,037) e ao isolamento de pacientes até que tenham dois exames laboratoriais negativos (p=0,032) foi menor em estabelecimentos maiores, em comparação com estabelecimentos de médio e pequeno porte. Conclusão: a adesão às medidas de mitigação da COVID-19 nas unidades brasileiras foi considerada excelente para a maioria das recomendações, independentemente do porte das unidades.

Abstract Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

Resumen Objetivo: evaluar la adhesión de instituciones brasileñas de larga estancia a las orientaciones de Prevención y Control de Infecciones de la Organización Mundial de la Salud y evaluar la asociación entre su tamaño y la adhesión a esas recomendaciones. Método: estudio transversal realizado con gerentes de establecimientos. Los autores desarrollaron un cuestionario de 20 ítems basado en estas directrices y un puntaje general de cumplimiento acorde a la observancia de estas recomendaciones. La adhesión se calificó (1) excelente para aquellas que cumplieron con ≥14 de 20 recomendaciones; (2) buena para 10 a 13 artículos; y (3) baja para aquellas con menos de diez elementos. El tamaño de las instalaciones se clasificó como pequeños, medianos y grandes de acuerdo con un análisis de clúster de dos pasos. Se utilizó estadística descriptiva y la prueba de chi-cuadrado con un nivel de significancia del 5%. Resultados: de las 362 instituciones incluidas, 308 (85,1%) se adhirieron a 14 o más recomendaciones. En cuanto a su tamaño, la adhesión al cribado de síntomas de COVID-19 de los visitantes (p=0,037) y al aislamiento de los pacientes hasta que tengan dos pruebas de laboratorio negativas (p=0,032) fue menor en los establecimientos más grandes en comparación con los establecimientos medianos y pequeños. Conclusión: la adhesión a las medidas de mitigación de la COVID-19 en las unidades brasileñas fue considerada excelente para la mayoría de las recomendaciones, independientemente del tamaño de las unidades.

Nurses and health care for gay adolescents / Enfermeiros diante do cuidado à saúde de adolescentes gays / Los enfermeros frente al cuidado de la salud de los adolescentes gays

Abstract Objective: to analyze nurses' statements about health care for gay adolescents. Method: qualitative study, anchored on the Thematic Analysis of Clarke and Braun, with adoption of Symbolic Interactionism as a theoretical framework, since it favors the understanding of the relationship between behaviors, interactions, and social meanings. Twelve nurses recruited using the snowball sampling technique were remotely interviewed via the Google Meet® video-conferencing app. Results: four themes were elaborated throughout the comprehensive-interpretative process: "Gay adolescents, agendas, and relation with health;" "The gay adolescent's family and care;" "Relationship with gay adolescents in care," and "Limits to nursing care for gay adolescents." Conclusion: the statements denounce stigmas and symbols derived from cisheteronormativity as intervening in the relationship and indicate the urgency of investing in the intersubjective encounter with gay adolescents and their families in a horizontal, affective, and empathic relationship, with chances of favoring public defense of the right to health. There are comments on the nurses' attitude and qualification of care for this population.

Resumo Objetivo: analisar narrativas de enfermeiros sobre o cuidado à saúde de adolescentes gays. Método: estudo qualitativo, ancorado na Análise Temática de Clarke e Braun, adotando como referencial teórico o Interacionismo Simbólico, uma vez que ele favorece a apreensão da relação de comportamentos, interações e significados sociais. Foram entrevistados remotamente 12 enfermeiros, recrutados a partir da técnica de bola de neve, por meio da plataforma de vídeo Google Meet ® . Resultados: ao longo do processo compreensivo-interpretativo, foram elaborados quatro temas: "Adolescente gay, pautas e relação com a saúde"; "A família do adolescente gay e o cuidado"; "Relação com adolescente gay no cuidado" e "Limites para o cuidar de enfermagem ao adolescente gay". Conclusão: as narrativas denunciam estigmas e símbolos derivados da cisheteronormatividade como intervenientes da relação e indicam premência de apostas no encontro intersubjetivo com os adolescentes gays e seus familiares em relação horizontal, afetiva e empática, com chances de favorecer defesa pública do direito à saúde. Há apontamentos para a atitude dos enfermeiros e qualificação do cuidado a essa população.

Resumen Objetivo: analizar los relatos de los enfermeros sobre el cuidado de la salud de los adolescentes gays. Método: estudio cualitativo, anclado en el Análisis Temático de Clarke y Braun, adoptando el Interaccionismo Simbólico como marco teórico, ya que favorece la aprehensión de la relación de comportamientos, interacciones y significados sociales. Fueron entrevistados remotamente 12 enfermeros, reclutados a partir de la técnica de bola de nieve, por medio de la plataforma de video Google Meet ® . Resultados: a lo largo del proceso comprensivo-interpretativo, se elaboraron cuatro temas: "Adolescente gay, pautas y relación con la salud"; "La familia del adolescente gay y el cuidado"; "Relación con adolescente gay en el cuidado" y "Límites para el cuidado de enfermería al adolescente gay". Conclusión: las narrativas denuncian los estigmas y símbolos derivados de la cisheteronormatividad como intervinientes de la relación e indican la urgencia de apuestas en el encuentro intersubjetivo con los adolescentes gays y sus familiares en relación horizontal, afectiva y empática, con posibilidades de favorecer la defensa pública del derecho a la salud. Hay apuntes para la actitud de los enfermeros y calificación del cuidado a esa población.

Integral health care for transgender adolescents: subsidies for nursing practice / Atenção integral à saúde dos adolescentes transgêneros: subsídios para a prática da Enfermagem / Atención integral a la salud de los adolescentes transgénero: subsidios para la práctica de la Enfermería

Abstract Objective: to analyze the integral health care for transgender adolescents from the perspective of their guardians. Method: qualitative research based on the Social Network framework proposed by Lia Sanicola, developed with 22 guardians of transgender adolescents in Brazil through semi-structured individual online interviews. The empirical material was analyzed using the content analysis technique, thematic modality. Results: lack of ambience was observed, in addition to technical unpreparedness of health professionals in relation to the theme at all levels of care, transphobia, centralization of care in scarce qualified services for transgender children and youth, absence of family support, lack of health promotion actions within the community, especially in the school environment, and the common support from non-governmental initiatives. Conclusion: the centralization of actions in scarce specialized services in the country, and the structural transphobia can compromise the integral health care for transgender adolescents. There is an urgent need for a network of care capable of assisting the joint action by multi and interdisciplinary teams, with greater proactivity of the nurse with the transgender adolescent and their guardians in individual and collective actions; ambience; health promotion in schools for visibility and support in Primary Health Care since childhood.

Resumo Objetivo: analisar a atenção integral à saúde dos adolescentes transgêneros na perspectiva dos seus responsáveis. Método: estudo qualitativo fundamentado no referencial Rede Social proposto por Lia Sanicola, desenvolvido com 22 responsáveis por adolescentes transgêneros no Brasil por meio de entrevistas online individuais semiestruturadas. O material empírico foi analisado com a utilização da técnica de análise de conteúdo na modalidade temática. Resultados: Foram evidenciados a falta de ambiência e despreparo técnico de profissionais da saúde em relação à temática em todos os níveis de atenção, transfobia, centralização do cuidado em escassos serviços habilitados para pessoas trans no período infantojuvenil, invisibilidade do apoio à família, ausência de ações de promoção da saúde no âmbito comunitário, sobretudo, escolar, e, ainda, o acolhimento promovido, comumente, pelas iniciativas não governamentais. Conclusão: a centralização de ações em escassos serviços especializados no país e a transfobia estrutural podem comprometer a atenção integral à saúde dos adolescentes trans. Urge a necessidade de uma linha de cuidado capaz de auxiliar a atuação conjunta por equipe multi e interdisciplinar com maior proatividade do enfermeiro junto ao adolescente trans e seus responsáveis por meio de ações individuais e coletivas; ambiência; promoção da saúde nas escolas para visibilidade e acolhimento na Atenção Primária à Saúde desde a infância.

Resumen Objetivo: analizar la atención integral a la salud de los adolescentes transgénero desde la perspectiva de sus responsables. Método: estudio cualitativo basado en el marco de la Red Social propuesto por Lia Sanicola, desarrollado con 22 responsables de adolescentes transgénero en Brasil a partir de entrevistas en línea individuales semiestructuradas. El material empírico fue analizado mediante la técnica de análisis de contenido, modalidad temática. Resultados: se ha evidenciado la falta de ambiente y preparación técnica de los profesionales de la salud con relación al tema en todos los niveles de atención, transfobia, centralización del cuidado en los pocos servicios habilitados para personas trans en el período infantojuvenil, invisibilidad del apoyo a la familia, ausencia de acciones de promoción de la salud en el ámbito comunitario, especialmente en la escuela, y la acogida comúnmente por las iniciativas no gubernamentales. Conclusión: la centralización de acciones en los pocos servicios especializados del país y la transfobia estructural pueden comprometer la atención integral en salud de los adolescentes trans. Urge una línea de cuidado capaz de auxiliar la acción conjunta de un equipo multi e interdisciplinario, con mayor proactividad del enfermero con el adolescente transgénero y sus responsables en acciones individuales y colectivas; ambiente; promoción de la salud en las escuelas para la visibilidad y acogida en la Atención Primaria de la Salud desde la infancia.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation). Aim: The aim of the study was to explore neonatologists' views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers. Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape. Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used. Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governance Conclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates. Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Outcomes of tuberculosis treatment in a tertiary health facility in north-central Nigeria

Background: Tuberculosis (TB) remains a major public health concern despite being a curable and preventable disease. The treatment of TB using a cocktail of drugs over a period of six months under the directly observed treatment short-course strategy has led to a reduction in cases but is plagued by some challenges that leads to unsuccessful or poor outcomes, which can ultimately result in spread of infections, development of drug resistance and increase in morbidity and mortality. The objectives of this study are to determine outcomes of TB treatment in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria and the factors that may be associated with the outcomes. Methodology: This was a retrospective study using the medical records of patients who were registered for TB treatment over a five-year period between 2016 to 2020. Data from TB registers including demographic and relevant clinical information, and treatment outcomes, were extracted into a structured data extraction format, and analysed with SPSS version 21.0 software package. Univariate and bivariate analyses were conducted, and Chi square test was used to determine association between TB outcomes and independent variables at 95% confidence interval and p<0.05 was considered as the significant value. Results: Records of 1,313 patients were studied, 744 (56.7%) were males while 569 (43.3%) were females. The age range of the patients was ≤ 1 year - 96 years, with a mean age of 30±16.7 years. Most were pulmonary TB cases (88.8%, n=1,166), newly diagnosed (95.5%, n=1254), and human immunodeficiency virus (HIV) negative at the time of TB diagnosis (63.7%, n=837). Eight hundred and seven (61.5%) patients had successful treatment, and 34% (n=446) had unsuccessful outcomes made of 'loss to follow-up' 25.8% (n=339), deaths 7.8% (n=102) and treatment failure 0.4% (n=5), while 2.3% (n=30) were transferred out and 2.3% (n=30) removed from TB register. Treatment success rate was significantly higher in patients with pulmonary TB (p=0.0024), residents in Lafia LGA (p=0.0005), those treated in 2016 (p=0.0006) and bacteriologically confirmed cases (p<0.0001), while death rate was significantly lower among patients who were HIV-negative at the time of TB diagnosis (p<0.0001). Conclusion: TB treatment success rate in this study fell short of the WHO average rate. High rates of 'loss to followup' and deaths in this study is a wake-up call to all stakeholders in the facility and the State to put in place measures to reduce poor outcomes of TB treatment.

Salivary lactoferrin levels, disease severity and correlates in patients with chronic periodontitis presenting to a tertiary health facility in Nigeria

Objective: This study compared the concentration of salivary lactoferrin in patients with and without chronic periodontitis and investigated correlations with clinical variables of the disease. Methods: The study included 102 participants (51 cases and 51 controls) who presented at the Periodontology Clinic of University of Benin Teaching Hospital and met the selection criteria of '4mm and above' periodontal probing depths (PPD) and positive bleeding on probing (BOP) using community periodontal index (CPI) probe. Healthy participants (controls) were patients that had PPD less than or equal to 3mm, absence of BOP and simplified oral hygiene index (OHI-S) not more than 1.2. Baseline OHI-S and CPI scores were recorded. Saliva samples were collected and analyzed using enzyme-linked immunosorbent assay. All data were analyzed with the Statistical Package for Social Sciences (SPSS) version 22.0. Results: There was a statistically significant difference between the mean (SD) lactoferrin concentration of control participants 5.27(0.59) mg/l and case participants 6.74(0.61) mg/l (p<0.001). Participants with probing pocket depths (PPD) of 6mm or more had a significantly higher mean concentration [6.85(0.06) mg/l] than that of those with PPD 4-5mm [6.71(0.67) mg/l] (p< 0.001)Lactoferrin levels were highest in participants with 'poor' oral hygiene [6.85(0.60) mg/l] and lowest in those with 'good' oral hygiene [6.65(0.83) mg/l]. Conclusion: Salivary lactoferrin levels were higher among participants with chronic periodontitis than those without chronic periodontitis and correlates positively with the main clinical characteristics of the disease

Caregivers' perception and determinants of delayed presentation of children with severe malaria in an emergency room in Benin City, Nigeria

Introduction: Severe malaria is a leading cause of mortality due to late presentation to health facilities. Hence, there is a need to identify and mitigate factors promoting delayed presentation with severe malaria. Objective: This study aimed to evaluate determinants of delayed presentation of children with severe malaria in a tertiary referral hospital. Methods: This study adopted a descriptive, cross-sectional design. The participants were children with a diagnosis of severe malaria, based on WHO diagnostic criteria. Delayed presentation was defined as presentation at the referral centre at >3 days of illness. Inferential analyses were done to identify factors associated with delayed presentation. P < 0.05 was considered statistically significant. Results: A total of 126 children with severe malaria participated in the study; their mean (standard deviation) age was 4.2 (5.3) years. The prevalence of delayed presentation in this study is 37.3%. Socio-economic class (P = 0.003); marital status (P = 0.015) and the number of health facilities visited before admission in the referral centre (P = 0.008) were significantly associated with delayed presentation. Children from upper socio-economic class were thrice more likely to present late, compared to those from lower social class (odds ratio [OR] = 3.728, 95% confidence interval [CI]: 1.694­8.208; P = 0.001). Likewise, the Yorubas were more delayed than the Binis (OR = 0.408, 95% CI: 0.180­0.928; P = 0.033). There was a negative correlation between caregivers' perception of treatment (r = −0.113, P = 0.21) of convulsion in severe malaria and timing of presentation. Conclusions: Delayed presentation is common with multifactorial determinants in the setting. Health education of caregivers on the consequences of delayed presentation in severe malaria is desirable.

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Maternal mortality in Ethiopia is the highest in the world (412/100,000). Health facility delivery is the cornerstone in reducing maternal mortality. However, health facility delivery is low in Ethiopia, due to poor access and ill-equipped health facilities. Maternity waiting home(MWH)is one of the comprehensive packages of essential obstetric services, enabling women to access well-equipped health facilities. However, there are limited studies on maternal waiting home use in Ethiopia. This study aimedto use the integrated behavioral model, toassess maternal waiting home use and associated factors among mothers in the East Bellessa district, northwest Ethiopia.Method:A community-based cross-sectional study was conducted fromthe1-27 of March 2020. The multistage sampling technique was used to select a total of 624 mothers. Data was collected usingthe face-to-face interview technique. The reliability and validity of the itemswere checked using exploratory factor analysis. Multivariable logistic regressions wereconducted toidentify the factors associated with maternal waiting home use. Findings with a p-value <0.05 with a 95% confidence interval were considered statistically significant in the final model.Result.Overall, 20.5% (95% CI=17.3-23.7) of mothers used maternity waiting homes for the index of childbirth. Husband educational status (AOR=3.78, CI =1.44-9.93), the knowledge on maternitywaiting homes(AOR=3.97, CI=2.27-6.95), between 2 and 3antenatal care follow ups(AOR=0.14 CI=0.06-0.31), experiential attitude (AOR=2.37, CI=1.64-3.44), descriptive norms(AOR=0.66, CI=0.47-0.94), perceived behavioral control (AOR=1.07, CI=1.02-1.13) and behavioral intention (AOR=1.37, CI=1.1-1.71) were associated with maternity waiting home use.Conclusion:Maternity waiting home utilization was low. Husband's education status, antenatal care follow-up, knowledge on maternal waiting homes, experiential attitude, descriptive norms, perceived behavioral control and behavioralintention were positively significantly associated with MWH utilization. Therefore, strengthening the use antenatal care services, husbands'education, and developing a positive attitude towards MWH may improve the use of maternity waitinghomesamong women. [Ethiop. J. Health Dev. 2022; 36(2):000-000]Keyword:Maternity waiting home, mothers,integrated behavioral model, Ethiopia

A comparative study of the effect of health insurance on women's use of health facility delivery: Evidence from demographic health survey in Benin Republic

Studies in the Benin Republic have identified contextual factors that determine health facility delivery among women of reproductive age. However, it is not certain if the same set of factors predicts facility delivery for women who enrolled in health insurance and those who did not. The study seeks to compare the determinants of health facility delivery for mothers under health insurance and those that are not in the Benin Republic. The study used data for 33,078 women of reproductive age, drawn from the most recent Benin demographic and health survey (2017-18). The characteristics of the women were described using simple proportions and frequency. Binary Logistic regression was used to examine determinants of health facility delivery for both groups of women. The result showed that only 0.7% of the women were under health insurance coverage. The prevalence of health facility delivery was high in the enrolled group but not in the unenrolled group (98.3% vs. 87.8%). The uniform determinants of health facility delivery across the two groups were household wealth, education, employment, land/house ownership, media exposure, a minimum of four antenatal contacts, and place of residence. To improve the coverage of health facility delivery, a multi-pronged approach should be used to improve household socioeconomic status, encourage media use among women, expand education opportunities for women, and specifically target rural women in Benin. (Afr J Reprod Health 2022; 26[6]:104-115).

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

Catastrophic Health Expenditure and Impoverishment from NonCommunicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. METHODS: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. RESULTS: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private: 24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status andthe number of admissions predicted impoverishment in public health facilities. CONCLUSION: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed