Development, Validation, and Utilization of a Social Media Use and Mental Health Questionnaire among Middle Eastern and Western Adults: A Pilot Study from the UAE.

OBJECTIVES: We aimed to develop and validate a mental health stigma measurement tool for use within the social media context, utilizing the tool to assess whether the stigma shown in face-to-face interactions translates to social media, coupled with comparing whether social media use can cause the stigma among a sample of Middle Eastern and Western populations. METHODS: The development and validation phase comprised a systematic process that was used to develop an assessment tool that could be used within the social media context and establish its validity and reliability. A 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) was developed to assess mental health stigma. The anonymous questionnaire was distributed from June 2022 to August 2022 on various social media platforms and groups predominated by the two demographics of interest, enrolling 1328 participants (with only 1001 responses deemed valid). The utilization phase consisted of bivariate and multivariable analysis of the data. The cutoff points for low, medium, and high scores were the 25th, 50th, and 75th percentil, respectively. RESULTS: The instrument comprised three dimensions: acceptance, intolerance, and digital care sentiment. In the Middle Eastern subset of participants, a higher score of intolerance (more stigma) toward mental illness was found in 72.4% of the participants, with a higher score of acceptance being 35.1% and of digital care sentiment being 46.4%. The mean scores for all the scales were as follows: intolerance (3.08 ± 0.64), acceptance (3.87 ± 0.71), and digital care sentiment (3.18 ± 0.69). For Westerners, a higher score of intolerance toward mental illness was found in 24.0% of the participants, with a higher score of acceptance being 56.8% and of digital care sentiment being 38.2%. The mean scores for all the scales were as follows: intolerance (2.28 ± 0.73), acceptance (4.21 ± 0.61), and digital care sentiment (3.08 ± 0.62). Various results were obtained regarding the effect of individual social media platforms on the different subscales. CONCLUSIONS: Stigma does follow people on social media, whether they are Middle Easterners or Westerners, although to varying degrees. The results of social media interaction and activity varied based on the group that used them, with some having an impact on one group but not the other. For these reasons, proper guidance is advised when utilizing and interacting with social media platforms.

Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa.

BACKGROUND: District hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency. METHOD: Data were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals. RESULTS: This study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals. CONCLUSION: Findings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples' health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.

Dietary diversity and impact of Moringa oleifera Lam. leaves supplemented - Diet on the nutritional status and CD4 cell counts of patients receiving antiretroviral therapy in Nigeria: A double - Blind randomized trial.

Background: To maintain an optimal nutritional status and immunological function in PLHIV, a diet with adequate nutrients is of utmost importance. This is a major challenge among poor populations in developing worlds like Nigeria, where malnutrition and food insecurity are endemic. This study aimed to assess the type of regular diet consumed and assess the impact of supplementation of the diet with Moringa oleifera Lam. leaves on the nutritional status and CD4 cell counts of PLHIV that are on ART in Nigeria. Method: A double-blind, randomized trial was conducted. Two hundred consented patients were randomly allocated to either the Moringa oleifera Lam. group (MOG) or the control group (COG). The FAO individual dietary diversity questionnaire was used. The regular diets of participants at baseline and six months were monitored. The measurements of weight, BMI, MUAC, and CD4 cell counts were obtained from baseline to six months of Moringa oleifera Lam. leaves supplementation. Results: One hundred and seventy-seven patients completed the six-month follow-up (89 MOG versus 88 COG). At both baseline and sixth month, the foods most commonly consumed by the participants in both MOG and COG were cereals, spices and condiments, oils, fats and palm oil, and dark green vegetables. At baseline, significantly higher consumption of legumes, nuts & seeds (p = 0.001) was observed in the MOG and higher consumption of other vegetables (p = 0.024) in COG. Consumption of cereals, roots, and tubers was significantly higher (p = 0.024; 0.045) in the COG in the sixth month. In both groups, participants were in the medium or low dietary diversity tercile. Throughout the study period, all the nutritional status variables observed were not significantly different between the two study groups [(p > 0.0001); weight; p = 0.5556; BMI; p = 0.5145; MUAC; p = 0.6456]. Over the study period, the treatment by time interaction shows a significant difference in CD4 counts by treatment group (p < 0.0001) and an estimate of fixed effects 10.33 folds greater in the MOG than COG. All tests were conducted at 95CI. Conclusion: This study revealed a poor dietary diversity amongst PLHIV. Supplementation of regular diet with Moringa oleifera Lam. leaves did not affect the nutritional status but could improve the immune response of HIV-positive adults attending the antiretroviral treatment centre in the present study area.

A double-blind, randomized controlled trial to examine the effect of Moringa oleifera leaf powder supplementation on the immune status and anthropometric parameters of adult HIV patients on antiretroviral therapy in a resource-limited setting.

BACKGROUND: People living with HIV (PLHIV) in resource-limited settings are vulnerable to malnutrition. Nutritional interventions aimed at improving food insecurity and malnutrition, together with antiretroviral therapy (ART), could improve treatment outcomes. In Nigeria, there is a high awareness of the nutraceutical benefits of Moringa oleifera. Thus, this study aimed to evaluate the effects of Moringa oleifera leaf supplementation on the CD4 counts, viral load and anthropometric of HIV-positive adults on ART. METHODS: This was a double-blind, randomized study. Two hundred HIV-positive patients were randomly allocated to either the Moringa Oleifera group (MOG) given Moringa oleifera leaf powder or the control group (COG) given a placebo. Changes in anthropometric parameters [weight; body mass index (BMI)] and CD4 cell counts were measured monthly for six months, while HIV-1 viral loads were measured at baseline and the end of the study for both groups. RESULTS: Over the study period, the treatment by time interaction shows a significant difference in CD4 counts by treatment group (p<0.0001). A further estimate of fixed effects showed that the CD4 counts among MOG were 10.33 folds greater than COG over the study period. However, the viral load (p = 0.9558) and all the anthropometric parameters (weight; p = 0.5556 and BMI; p = 0.5145) between the two groups were not significantly different over time. All tests were conducted at 95CI. CONCLUSION: This study revealed that Moringa oleifera leaf supplementation was associated with increased CD4 cell counts of PLHIV on ART in a resource-limited setting. Programs in low-resource settings, such as Nigeria, should consider nutritional supplementation as part of a comprehensive approach to ensure optimal treatment outcomes in PLHIV.

Impact of Moringa Oleifera leaves supplementation on quality of life of people living with HIV: A double-blind randomized controlled trial.

PURPOSE: Advances in antiretroviral therapy (ART) and increased interest on nutritional interventions have led to improvements in life expectancy of people living with HIV (PLHIV). These have led to greater emphasis on their quality of life (QoL). This study was aimed at exploring the effects of Moringa oleifera leaves supplementation on QoL of HIV-positive adults in Nigeria. METHOD: A double-blind randomized controlled trial was conducted to determine the six months' impact of consuming Moringa oleifera leaves powder as a nutritional supplement on the different domains of QoL of PLHIV that are on ART. Two hundred consented patients were randomly allocated to either Moringa Oleifera group (MOG) or control group (COG). The WHOQOL-HIV-BREF was used to assess QoL at baseline and at six-month follow-up. RESULTS: One hundred and seventy seven patients completed the study. At six-month follow-up, a significant (p < 0.05) increase in the mean scores of all the six domains of QoL was observed in the MOG. However, in the COG, a significant increase was observed in the social relationship, environment, and spirituality/religion/personal beliefs domains. The comparison between the MOG and COG at 6 months' follow-up showed a significant mean score difference in the MOG in the physical, psychological, level of independence, and social relationships domains of QoL. CONCLUSION: This study shows that supplementation with Moringa oleifera leaves for PLHIV that are on ART improves the QoL domains of physical, psychological, level of independence, and social relationships. Clinical Trial Registry registration number: PACTR201811722056449.

Technical efficiency and productivity of public district hospitals in KwaZulu-Natal province, South Africa.

Background: District hospitals (DHs) constitute a significant proportion of public hospitals and consume a more substantial percentage of the government's total hospital budget. With the level of resources disbursed to DHs, it is essential to ensure efficient allocation and utilization. Hence, this study set out to assess the technical efficiency and productivity of public DHs in KwaZulu- Natal province, South Africa. Methods: Data envelopment analysis (DEA) and Malmquist total factor productivity (MTFP) were used to assess technical efficiency, identify adjustments required to make inefficient facilities more efficient, and determine overall productivity growth. Input data such as medical personnel and output information such as outpatient visits were retrieved from the databases of the district health information system (DHIS), and personnel salary systems (PERSAL) for three consecutive financial years (2014/15, 2015/16 and 2016/17). A total of 38 district hospitals were included in the study. Results: The proportion of technically efficient facilities according to constant return to scale (CRS) were 12 (31.6%), 16 (42.1%) and 14 (36.8%) in 2014/15, 2015/16 and 2016/17 respectively while according to the variable return to scale (VRS) technically efficient facilities were 22 (57.9%), 19 (50.0) and 21 (55.2%) respectively for the three consecutive years. On average, the total productivity of DHs increased by 4.8 percent over the three years, which is attributed majorly to technical growth of 6.9 percent. Conclusion: This study showed that a significant proportion of the district hospitals were technically inefficiency. Also, steps that could enable more efficient use of healthcare resources to yield optimal health service delivery were recommended.

Assessing the Efficiency of Health-care Facilities in Sub-Saharan Africa: A Systematic Review.

BACKGROUND: The provision of health-care services is dependent on the effective and efficient functioning of various components of a health-care system. It is therefore important to evaluate the functioning of these various components. Hence, the aim of this study was to review studies on health-care facilities efficiency in sub-Saharan Africa (SSA) with respect to the methodologies used as well as outcomes and factors influencing efficiency. METHODS: The review was conducted through a comprehensive search of electronic databases which included PubMed, Web of science, academic search complete via EBSCOhost, Science Direct, and Google scholar. A search was also conducted by looking into citations in the reference list of selected articles and through gray literature. Studies were screened by examining their titles, abstracts, and full-text based on stated inclusion and exclusion criteria. The concurrent screening and data extraction were conducted by the two authors. RESULTS: A total of 40 studies were shortlisted for the review. The majority (90.0%) of the studies employed the data envelopment analysis technique for their efficiency measurements. The input and output variables utilized by most of the studies were predominantly human resources and health-related services respectively. The outcome from majority of the studies showed that less than 40% of the studied facilities were efficient. The leading influencing factors reported by the studies were catchment population, facility ownership, and location. CONCLUSIONS: The review showed that there was a marked degree of inefficiency across the health-care facilities. Consequently, due to severe resource constraints facing SSA, there is a need to determine how to use the available resources optimally to improve health systems performance.

Protocol for Investigating the Technical Efficiency of District Hospitals in the Public Health Sector of KwaZulu-Natal, South Africa.

BACKGROUND: The central objective of policy makers and health managers is efficiency in the delivery of health care. With frequent reports of global economic crises, there is a need to continuously measure the performance of various sectors of the health care system. This can inform the decision-making process toward allocating scarce resources with the aim of maximizing output. OBJECTIVE: The aim of this study is to determine the technical efficiency (TE) of public sector district hospitals in the province of KwaZulu-Natal, South Africa to provide information that will assist in policy formulation that may further assist in more efficient resource allocation decisions. METHODS: This is a health system research based on a quantitative research approach. All 38 public district hospitals in the 11 municipalities of the province will be included in this study. The data for the study will include inputs from hospitals' operations that contribute toward subsequent outputs. The input data will include information such as the number of health professionals (doctors, nurses, and other personnel) and number of hospital beds, whereas the output data will include information such as outpatient visits and number of admissions or discharge. Other data categories to be included will be determined by data availability and will be uniform for all facilities. Data for each facility for a 3-year period from 2014 to 2017 will be obtained from databases of the district health information, basic accounting, and personnel salary systems. On the basis of the data obtained, a model will be developed that can be used to assess how TE of public districts hospitals may be improved. TE will be determined using Data Envelopment Analysis, and factors influencing efficiency will be computed using StataCorp statistical package. RESULTS: As of February 2019, the study is at the data collection, data input, and analysis stages. The results are expected to be available from the second quarter of 2019. CONCLUSIONS: Findings from this study can add to tools available to policy makers, health planners, and managers in making decisions about resource allocation in health care systems. Moreover, these findings will be disseminated electronically and in print. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12037.