A qualitative study to investigate Swiss hospital personnel's perceived importance of and experiences with patient's mental-somatic multimorbidities.

BACKGROUND: Mental-somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel's perceived importance of and experiences with mental-somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. METHODS: Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. RESULTS: Four themes emerged from the data analysis: 1) the relevance of mental-somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental-somatic multimorbidity, and 4) interprofessional collaboration for handling mental-somatic multimorbidity in hospital settings.The mental-somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental-somatic multimorbidity in general hospitals. CONCLUSION: To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental-somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.

Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania.

OBJECTIVES: To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania. DESIGN: A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation. SETTING: Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July-August 2018. PARTICIPANTS: Representative sample of 629 adults ≥18 years of age. MAIN OUTCOMES MEASURES: (1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients' decision to attend a given provider. Data were analysed using mixed logistic regression models. RESULTS: Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were 'quality of care' and 'healthcare professionals' attitudes. Solely looking at patients using a public provider, 'geographical proximity' was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider's patients, the 'availability of diagnostic devices' was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56). CONCLUSION: The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.

Nutritional status of Tajik children and women: Transition towards a double burden of malnutrition.

The double burden of malnutrition, an emerging concern in developing countries, can exist at various levels: individual, household, and population. Here, we explore the nutritional status of Tajik women (15-49 years) and children (5-59 months) focusing on overweight/obesity along with undernutrition (underweight, stunting, and micronutrient deficiencies). For this, nutritional markers (haemoglobin (Hb), transferrin receptor (TfR), serum ferritin (Sf), retinol binding protein (RBP), vitamin D, serum folate, and urinary iodine), height, and weight were assessed from 2,145 women and 2,149 children. Dietary intake, weaning, and breastfeeding habits were recorded using a 24-hr recall and a questionnaire. Overweight (24.5%) and obesity (13.0%) are increasing among Tajik women compared with previous national surveys (2003 and 2009). Prevalence of iron deficiency and anaemia was 38.0% and 25.8%, respectively; 64.5% of women were iodine deficient, 46.5% vitamin A deficient, and 20.5% had insufficient folate levels. Women in rural areas had significantly lower iron status and body mass index and higher iodine intake compared with urban areas; 20.9% of children were stunted, 2.8% wasted, 6.2% underweight, 52.4% iron deficient, and 25.8% anaemic; all more prominent in rural areas. Dietary diversity was higher among urban women. Intraindividual or household double burden was not seen. In summary, double burden of malnutrition constituted an increase in overweight among women, especially in urban areas, and persisting levels of undernutrition (stunting, iron, and vitamin A deficiency), predominately in rural areas. A holistic, innovative approach is needed to improve infant and young children feeding and advise mothers to maintain an adequate diet.

How does membership in local savings groups influence the determinants of national health insurance demand? A cross-sectional study in Kisumu, Kenya.

BACKGROUND: Rotating savings and credit associations (ROSCAs) are highly active in many sub-Saharan African countries, serving as an important gateway for coping with financial risk. In light of the Kenya's National Hospital Insurance Fund's (NHIF's) strategy of targeting ROSCAs for membership enrolment, this study sought to estimate how ROSCA membership influences the determinants of voluntary health insurance enrolment. METHODS: A cross-sectional survey of 444 households was carried out in Kisumu City between July and August 2016. A structured questionnaire was administered on health insurance membership, household attributes, headship characteristics and health-seeking behaviour. We assessed the influence of ROSCA membership on the associations between NHIF enrolment and the explanatory variables using univariate logistic regression. RESULTS: The study found that education was associated with NHIF demand regardless of ROSCA membership. Both ROSCA and non-ROSCA households with high socioeconomic status showed stronger health insurance demand compared with poorer households; there was, however, no evidence that the strength of this association was influenced by ROSCA status (p-value = 0.47). Participants who were self-employed were significantly less likely to enrol into the NHIF if they did not belong to a ROSCA (interaction test p-value = 0.03). NHIF enrolment was found to be lower among female-headed households. There was a borderline effect of ROSCA membership on this association, with a lower odds ratio amongst non-ROSCA members (p-value = 0.09): the low treatment numbers amongst the insured infers that ROSCA membership may play a role on the association between gender and NHIF demand. CONCLUSIONS: Our findings suggest that ROSCA membership may play a role in increasing health insurance demand amongst some traditionally under-represented groups such as women and the self-employed. However, the strategy of targeting ROSCAs to increase national health insurance enrolment may yield exiguous results, given that ROSCA membership is itself influenced by several non-observable factors - such as time-availability and self-selection. It is therefore important to anchor outreach to ROSCAs within a broader, multi-pronged approach that targets households within their social, economic and political realities.

Community health outreach program of the Chad-Cameroon petroleum development and pipeline project.

A critical appraisal has been presented of the CHOP for a large-scale energy infrastructure development project that was implemented in two of the world's poorest countries. The project is under close scrutiny from various independent monitoring groups, civil society organizations, and human rights groups. Reviewing the achievements and shortcomings permits the extraction of important lessons that will be critical for the future adoption of the CHOP in the current setting and for the implementation of additional CHOPs elsewhere in the developing world. The authors believe that the design must be flexible, efficient, and innovative so that a CHOP promptly can address pressing public health issues as they arise (eg, epidemic outbreak) and include the needs and demands of the concerned communities. An innovative feature of the current project is the high degree and mix of public-private partnerships. The project's CHOP also relies on partnerships. As elaborated elsewhere, public-private partnerships should be seen as a social experiment--they reveal promise but are not the solution for every problem. For this CHOP, the focus is on partnerships between a multinational consortium, government agencies, and international organizations. The partnerships also include civil society organizations for monitoring and evaluation and local NGOs designated for the implementation of the selected public health interventions within the CHOP. The governments and their respective health policies often form the umbrella under which the partnerships operate. With the increase in globalization, however, the importance and capacities of governments have diminished, and there is growing private-sector involvement. Private enterprise is seen as an efficient, innovative, pragmatic, and powerful means to achieve environmental and social sustainability. Experiences with the partnership configurations in the current CHOP are of importance for tackling grand challenges in global health by applying a systemic approach. Other innovations of the project in general, and the CHOP in particular, are the strong emphases on institutional-capacity building, integration, and sustainability. In countries like Chad and Cameroon, there are serious shortages of well-qualified health personnel. The CHOP described in this article provides leverage for initiating better healthcare that will reduce the high burden of disease in the developing world. Reducing mortality rates for infants and children younger than 5 years in sub-Saharan Africa requires massive scaling-up of malaria-control interventions (eg, large-scale distribution of ITNs to protect millions of African children), thereby approaching the Abuja targets (see Armstrong Schellenberg et al). The local NGOs that took a lead within the framework of the CHOP in the distribution of ITNs and accompanying health education messages can extend these activities to communities living outside the vicinity of the project area. Serious shortcomings of the current CHOP, consistently identified by the external monitoring groups, include the lack of a regional health plan, cumulative impact assessment, and provision of clean water and sanitation outside the narrowly defined project area. This point is of central importance, particularly for Chad, where access to clean water and improved sanitation facilities is low. Another limitation of the current CHOP is the insufficient amount of significance addressed to tuberculosis and the apparent lack of concerted control efforts against HIV infection, AIDS, and tuberculosis. These criticisms, however, must be balanced against the lack of clarity in international discourse about the proper extent of responsibility of the corporate sector for dealing with the health problems of countries in which they do business. In an elegant analysis, the environmental risk factor "unsafe water, sanitation and hygiene" was shown to be one of the major contributors to loss of healthy life, particularly in the developing world. Provision of clean water and sanitation is a key factor for sustainable control of schistosomiasis and soil-transmitted helminths. Reduction of helminth infections might have a beneficial effect on the HIV and AIDS pandemic. The question still remains: What is, or should be, the scope and limits of responsibility of the corporate sector in solving these problems? There is a critical need for the monitoring and evaluation of the long-term impact of a CHOP that develops in parallel with a large development project, emphasizing the broadest possible determinants of health and well-being. To become operational, it requires the establishment and running of a longitudinal demographic surveillance system in the area and in adjacent areas that are unlikely to be affected by the project. This approach, coupled with regular household surveys for in-depth appraisal of health-seeking and asset indices, is the most promising source of data for impact measurement of health, poverty, and equity-related issues. It will facilitate subtle monitoring and surveillance activities, fostering a truly systemic approach by inclusion of all stake holders on the basis of the existing but constantly evolving system.