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1.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 488-502, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480942

RESUMO

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.


Assuntos
Cuidado da Criança , Menores de Idade/psicologia , Comportamento Problema , Qualidade de Vida , Refugiados/psicologia , Adolescente , Criança , Cuidado da Criança/organização & administração , Alemanha , Instalações de Saúde , Humanos
2.
Pan Afr Med J ; 33(Suppl 2): 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402968

RESUMO

Introduction: in spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required. Methods: multi-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs). Results: the assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level. Conclusion: public health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users' concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Vigilância em Saúde Pública/métodos , Saúde Pública , Análise por Conglomerados , Comunicação , Confiabilidade dos Dados , Instalações de Saúde/estatística & dados numéricos , Humanos , Libéria/epidemiologia , Projetos Piloto , Reprodutibilidade dos Testes , Risco , Inquéritos e Questionários
3.
Stud Health Technol Inform ; 264: 1373-1377, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438151

RESUMO

This paper presents results concerning the traceability of a secure data collection infrastructure based on the Bloom Filter involving standardized electronic medical record (EMR) storage. The objective of this infrastructure is to facilitate rapid secondary use of exported EMR data in cross-patient or cross-institutional analyses based on the Standardized Structured Medical Information eXchange (SS-MIX), Japan's domestic standard for EMR export. Secondary use of EMR data should be based on the principle of patient consent. Therefore, securing the traceability of patient EMR data is important for achieving reliable data collection systems for secondary use. Blockchain is a strong candidate, and we evaluated its performance using several implementations. As shown by the evaluation, it is difficult to realize the method of recording the query history of secondary use on the blockchain. We thus propose a method for recording index information of distributed log data.


Assuntos
Registros Eletrônicos de Saúde , Troca de Informação em Saúde , Instalações de Saúde , Humanos , Japão
4.
Lima; Perú. Ministerio de Salud; 20190700. 14 p. tab.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1005707

RESUMO

Contribuir al cumplimiento de los principios de bioseguridad y los lineamientos de vigilancia, prevención y control de las infecciones asociada a la atención de la salud; así como a la adecuada identificación del personal de la salud por parte de los usuarios de los servicios, al estandarizar la indumentaria de trabajo del personal técnico y auxiliar asistencial de la salud de las entidades conformantes del Sector Salud.


Assuntos
Vestuário , Normas Técnicas , Instalações de Saúde , Recursos Humanos
5.
Lima; Perú. Ministerio de Salud; 20190700. 64 p. graf, tab.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1006654

RESUMO

Contribuir a la conservación , funcionamiento y seguridad de las calderas de vapor pirotubulares que funcionan en los establecimientos de salud.


Assuntos
Manutenção de Equipamento , Energia de Vapor , Instalações de Saúde
6.
Lima; Perú. Ministerio de Salud; 20190700. 20 p.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1006655

RESUMO

Fortalecer la organización del sector salud, para una oportuna y adecuada respuesta, ante la inminencia u ocurrencia de un evento adverso, emergencia o desastre, que pone en riesgo la salud de la población y el funcionamiento de los establecimientos.


Assuntos
Alerta em Desastres , Planos de Contingência , Emergências , Instalações de Saúde , Diagnóstico da Situação de Saúde , Assistência Ambulatorial
7.
J Glob Health ; 9(2): 020406, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360446

RESUMO

Background: Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods: We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results: The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions: The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Fatores de Tempo , Adulto Jovem
8.
Zhonghua Yi Xue Za Zhi ; 99(27): 2135-2140, 2019 Jul 16.
Artigo em Chinês | MEDLINE | ID: mdl-31315386

RESUMO

Objective: To describe the secular trends of institutional delivery (ID) rate in minority inhabited areas of China from 1996 to 2017 according to national health policies. Methods: The number of live births and IDs for each county/district in 31 provinces of China were derived from the datasets collected by the Office for National Maternal & Child Health Statistics of China. Information on health policies and ethnical areas was derived from official governmental websites. The calendar years were divided into three periods: pre-program period (1996 to 1999), program implementation period (2000 to 2008) and post-program period (2009 to 2017). Minority autonomous regions, autonomous prefectures, and autonomous counties were defined as minority inhabited areas. The ethnic that a county was classified into was determined by a principle of close proximity to the name of the county or its next higher level administrative division. A total of 700 counties in minority inhabited areas were included in the analysis. Results: A total of 45 684 265 live births including 35 098 855 delivered in institutions were analyzed. The ID rate in minority inhabited areas was 37.5% (696 221/1 856 164) in 1996 and 99.2% (2 371 209/2 390 131) in 2017, with an annual growth rate of 4.7%. During the 22-years period, the ID rates in the eastern, central and western regions increased simultaneously, with the annual growth rates of 3.1%, 4.2% and 4.9% respectively. The difference between the eastern and western regions decreased steadily from 16% in 1996 to <1% in 2017 and the difference between the urban and rural areas decreased from 32.1% in 1996 to <1% in 2017. Besides, the ID rates in Tibetan and Yi inhabited areas with lower baseline levels increased 73 and 63 percentage points respectively. The number of counties with the ID rate of <96% were substantially reduced from 589 in 1996 to 72 in 2017; the 71 counties were all located in national deep poverty-stricken areas named Three Districts and Three States, predominantly involving Tibetan (58), Yi (6), Uygur (2) and Lisu (2) ethnics. Conclusion: During the past 22 years, the ID rate in minority inhabited areas in China has dramatically increased, achieving the goal of 2 020 ahead of schedule, but there remains a few western counties where ID rates are still<96%, indicating that minority inhabited western areas should be focused in developing national policies concerning institutional delivery.


Assuntos
Instalações de Saúde , Grupos Minoritários , China , Grupos Étnicos , Política de Saúde , Humanos
9.
J Forensic Leg Med ; 67: 1-6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352158

RESUMO

OBJECTIVES: This study aims to extend the current understanding of violence against health professionals and facilities in China, with data from an authoritative, national-representative, but under-researched data source - litigation records, and discuss implications for developing violence prevention strategies. DESIGN: We collected all legal cases relevant to violence against health professionals and facilities from criminal ligation records released by the Supreme Court of China from 2010 to 2016. MAIN OUTCOME MEASURES: (i) Characteristics of perpetrators: gender, age, education, occupation, history of mental illness and alcohol; (ii) characteristics of victims: medical specialization, location, type of violence; (iii) outcome of treatment. RESULTS: 140 cases were collected for analysis. Beating, pushing, verbal abuse, threatening, burning mock paper money, placing a corpse in the hospital, hanging banners, blocking hospital gates and doors, and smashing hospital property were the most frequently reported types of violence. Specifically following patient deaths, the interval between a patient's death and violence by the patient's families and friends was short, with 51% happening on the same day. CONCLUSIONS: Our study provides a comprehensive overview of violence against health professionals and facilities in China, which can be used to inform the development of prevention strategies.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Intoxicação Alcoólica/epidemiologia , China/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Imperícia/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Distribuição por Sexo , Violência no Trabalho/legislação & jurisprudência , Adulto Jovem
11.
BMC Public Health ; 19(1): 714, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174500

RESUMO

BACKGROUND: In the context of an ageing population and an increase in the appearance of chronic diseases, the commitment of caregivers makes it possible for people confronted with disease to remain at home. Over time, they need support to overcome their difficulties. They also show a need for recognition for their participation in the economic maintenance of the health system. To promote this support, so-called "win/win" partnerships are envisaged. Research is needed to identify the building blocks of an innovative intervention. METHODS: A cross-sectional descriptive study was carried out with health institutions in the canton of Geneva to identify the proportion of institutions with a positive opinion on partnership with caregivers. It has also identified potential partnerships with caregivers of people facing dementia and possible compensation in exchange for the provision of their skills. Descriptive statistics are presented according to their frequencies and relative percentages (categorical variables), as well as by their mean, standard deviation and median (continuous variables). Logistic regression models were used to assess the factors associated with a favorable opinion towards win/win partnerships. RESULTS: The proportion of executives of health-related institutions with a positive opinion of partnership with caregivers is high: 74.7% (95% CI: 64.8-83.1%). Several types of potential partnerships have been identified between health institutions and caregivers. Areas in which certain activities have been identified as being able to be carried out by caregivers include governance, care, provision of services, accompaniment and support, training and research. Types of compensation for caregivers have also been highlighted. CONCLUSION: This study shows that some areas activities of health facilities in the canton of Geneva could be the subject of win-win partnerships with caregivers of people with dementia. Positive view of health executives on partnership with caregivers is encouraging. In the future, innovative projects can emerge to meet the needs of each party.


Assuntos
Cuidadores/organização & administração , Redes Comunitárias , Demência/terapia , Instalações de Saúde , Colaboração Intersetorial , Idoso , Cuidadores/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Suíça
12.
BMC Health Serv Res ; 19(1): 421, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238935

RESUMO

BACKGROUND: Client-centric quality of care (QoC) in family planning (FP) services are imperative for contraceptive method adoption and continuation. Less is known about the choice of contraceptive method in India beyond responses to the three common questions regarding method information, asked in demographic and health surveys. This study argues for appropriate measurement of method choice and assesses its levels and correlates in rural India. METHODS: A cross-sectional study was conducted with new acceptors of family planning method (N = 454) recruited from public and private health facilities in rural Bihar and Uttar Pradesh, the two most populous states in India. The key quality of care indicator 'method choice' was assessed using four key questions from client-provider interactions that help in making a choice about a particular method: (1) whether the provider asked the client about their preferred method, (2) whether the provider told the client about at least one additional method, (3) whether the client received information without any single method being promoted by the provider, and (4) client's perception about receipt of method choice. The definition of method choice in this study included women who responded "yes" to all four questions in the survey. The relationship between contraceptive communication and receipt of method choice was assessed using logistic regression analyses, after adjusting for socio-demographic characteristics of the respondents. RESULTS: Although 62% of clients responded to a global question and reported that they received the method of their choice, only 28% received it based on responses about client-provider interactions. Receipt of the information on side-effects of the selected method (Adjusted Odds Ratio [AOR]: 7.4, 95% Confidence Interval [CI]: 3.96-13.86) and facility readiness to provide a range of contraceptive choice (AOR: 2.67, 95% CI: 1.48-4.83) were significantly associated with receipt of method choice. CONCLUSIONS: Findings demonstrated that women's choice of contraceptive could be improved in rural India if providers give full information prior to and during the acceptance of a method and if facilities are equipped to provide a range of choice of contraceptive methods.


Assuntos
Comportamento de Escolha , Anticoncepção/psicologia , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Serviços de Saúde Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Índia , Gravidez , Adulto Jovem
13.
Environ Monit Assess ; 191(Suppl 2): 279, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254116

RESUMO

The well-being of a population and its health are influenced by a myriad of socioeconomic and environmental factors that interact across a wide range of scales, from the individual to the national and global levels. One of these factors is the provision of health services, which is regulated by both demand and supply. Although an adequate provision can significantly improve health outcomes of a population, lopsided flow of patients to specific health centers can result in serious disparities and potentially delay the timeliness of a diagnosis. In this paper, utilization patterns during an epidemic of dengue fever in the city of Cali, Colombia for the year 2010 are investigated. Specifically, the objectives are to (1) identify health facilities that exhibit patterns of over- and underutilization, (2) determine where patients who are being diagnosed at a particular facility originate from, and (3) whether patients are traveling to their closest facility and hence (4) estimate how far patients are willing to travel to be diagnosed and treated for dengue fever. Analysis is further decomposed by age group and by gender, in an attempt to test whether utilization patterns drastically change according to these variables. Answers to these questions can help health authorities plan for future epidemics, for instance, by providing guidelines as to which facilities require more resources and by improving the organization of health prevention campaigns to direct population seeking health assistance to use facilities that are underutilized.


Assuntos
Dengue/epidemiologia , Surtos de Doenças , Monitoramento Ambiental , Adulto , Cidades , Colômbia/epidemiologia , Dengue/terapia , Dengue/virologia , Feminino , Sistemas de Informação Geográfica , Instalações de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Viagem
14.
J Forensic Leg Med ; 66: 33-37, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31202089

RESUMO

This study explores the experiences of people who have attended Saint Mary's Sexual Assault Referral Centre (SARC) for a forensic medical examination (FME). Within the United Kingdom, SARCs support complainants following a sexual assault, delivering specialised care and gathering medico-legal evidence for court proceedings. To date, there has been limited research evaluating SARCs responses towards complainants. 863 Feedback and Evaluation forms, from a three-year period, completed by clients who had accessed Saint Mary's SARC's forensic medical examination service were evaluated. Descriptive statistical analysis found a large majority of clients were 'very satisfied' with the crisis worker, forensic physician and police. Content analysis of the free text responses found more nuanced experiences, which impacted clients overall experience within the SARC. These comments were split into two themes, 'Compliments' and 'Suggestions for improvement'. There were 404 comments focusing on compliments of the service and the staff. Compliments included messages of thanks, with praise for professionalism of the staff and importance of the service. Clients noted in particular that the FME service was delivered in challenging circumstances i.e. the immediate aftermath of a sexual assault. There were 34 comments which made suggestions for improvements. These suggestions focused on pragmatic and logistic issues.


Assuntos
Vítimas de Crime , Instalações de Saúde , Satisfação do Paciente/estatística & dados numéricos , Exame Físico , Delitos Sexuais , Adolescente , Adulto , Distribuição por Idade , Vítimas de Crime/estatística & dados numéricos , Feminino , Medicina Legal , Humanos , Masculino , Distribuição por Sexo , Inquéritos e Questionários , Reino Unido , Adulto Jovem
15.
BMC Public Health ; 19(1): 718, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182068

RESUMO

BACKGROUND: In Ghana, limited evidence exists about the geographical accessibility to health facilities providing tuberculosis (TB) diagnostic services to facilitate early diagnosis and treatment. Therefore, we aimed to assess the geographic accessibility to public health facilities providing TB testing services at point-of-care (POC) in the Upper East Region (UER), Ghana. METHODS: We assembled detailed spatial data on all 10 health facilities providing TB testing services at POC, and landscape features influencing journeys. These data were used in a geospatial model to estimate actual distance and travel time from the residential areas of the population to health facilities providing TB testing services. Maps displaying the distance values were produced using ArcGIS Desktop v10.4. Spatial distribution of the health facilities was done using spatial autocorrelation (Global Moran's Index) run in ArcMap 10.4.1. We also applied remote sensing through satellite imagery analysis to map out residential areas and identified locations for targeted improvement in the UER. RESULTS: Of the 13 districts in the UER, 4 (31%) did not have any health facility providing TB testing services. In all, 10 public health facilities providing TB testing services at POC were available in the region representing an estimated population to health facility ratio of 125,000 people per facility. Majority (60%) of the health facilities providing TB testing services in the region were in districts with a total population greater than 100,000 people. Majority (62%) of the population resident in the region were located more than 10 km away from a health facility providing TB testing services. The mean distance ± standard deviation to the nearest public health facility providing TB testing services in UER was 33.2 km ± 13.5. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest facility providing TB testing services in the UER was 99.6 min ± 41.6. The results of the satellite imagery analysis show that 51 additional health facilities providing TB testing services at POC are required to improve geographical accessibility. The results of the spatial autocorrelation analysis show that the spatial distribution of the health facilities was dispersed (z-score = - 2.3; p = 0.02). CONCLUSION: There is poor geographic accessibility to public health facilities providing TB testing services at POC in the UER of Ghana. Targeted improvement of rural PHC clinics in the UER to enable them provide TB testing services at POC is highly recommended.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Tuberculose/diagnóstico , Diagnóstico Precoce , Feminino , Geografia , Gana , Humanos , Masculino , Programas de Rastreamento/métodos , População Rural/estatística & dados numéricos , Análise Espacial , Viagem
16.
BMC Public Health ; 19(1): 677, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159775

RESUMO

BACKGROUND: Home delivery is the most frequent childbirth practice in Ethiopia and brings health risks for many mothers and their babies which in turn affecting the whole families. Characterizing the spatial variations and the associated factors of home deliveries after antenatal care visit is necessary to prioritize risks and facilitate geographically based interventions. METHOD: A community-based cross-sectional study design was carried out between February and March 2016. A total of 528 women who had just given birth were interviewed face-to-face using a questionnaire. Geo-referenced data were collected using a handheld global positioning system (GPS). The Bernoulli model was applied using the SatScan ™ software to analyze the purely spatial clusters of home deliveries. ArcGIS version 10.1 was used to visualize clusters of home delivery. RESULTS: The overall proportion of home deliveries was 278(52.7%), and home deliveries had spatial variations. A primary cluster [LLR = 14.54, p < 0.001] was detected in village of Safida Giorgis. Secondary clusters were detected in Checheho [LLR = 9.17, p < 0.05] and ZurAmba [LLR = 8.51, p < 0.05]. Predictors for home delivery included the distance between the health extension worker's and mother's house [AOR = 2.2, 95% CI: 1.1, 4.3], residence [AOR = 3.8, 95% CI: 1.3, 10.9], source of information for ANC [AOR = 0.3, 95% CI: 0.13, 0.7], ANC visits [AOR = 6.1, 95% CI:1.9, 19.3], health education [AOR = 3.4, 95% CI: 1.5, 7.4], decision on place of delivery [AOR = 0.3, 95% CI: 0.1, 0.8], and knowledge on place of delivery [AOR = 0.04, 95% CI: 0.0, 0.1]. CONCLUSION: The proportion of home delivery after ANC visit was decreasing compared to other studies conducted in the region. In addition, spatial variations of home delivery were observed in the study area. Promoting women's education and behavioral change communication at the grass root level, provision of the services both at home and health facilities and improving the quality and capacity of the health providers are some of the recommendations forwarded.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde , Parto Domiciliar , Cuidado Pré-Natal , Adolescente , Adulto , Estudos Transversais , Tomada de Decisões , Etiópia , Feminino , Sistemas de Informação Geográfica , Educação em Saúde , Instalações de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Humanos , Mães , Razão de Chances , Parto , Gravidez , Análise Espacial , Inquéritos e Questionários , Adulto Jovem
18.
BMC Infect Dis ; 19(1): 489, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151423

RESUMO

BACKGROUND: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. METHODS: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. RESULTS: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays. CONCLUSION: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
20.
Malar J ; 18(1): 195, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186004

RESUMO

BACKGROUND: The disease burden of Plasmodium falciparum malaria illness is generally estimated using one of two distinct approaches: either by transforming P. falciparum infection prevalence estimates into incidence estimates using conversion formulae; or through adjustment of counts of recorded P. falciparum-positive fever cases from clinics. Whilst both ostensibly seek to evaluate P. falciparum disease burden, there is an implicit and problematic difference in the metric being estimated. The first enumerates only symptomatic malaria cases, while the second enumerates all febrile episodes coincident with a P. falciparum infection, regardless of the fever's underlying cause. METHODS: Here, a novel approach was used to triangulate community-based data sources capturing P. falciparum infection, fever, and care-seeking to estimate the fraction of P. falciparum-positive fevers amongst children under 5 years of age presenting at health facilities that are attributable to P. falciparum infection versus other non-malarial causes. A Bayesian hierarchical model was used to assign probabilities of malaria-attributable fever (MAF) and non-malarial febrile illness (NMFI) to children under five from a dataset of 41 surveys from 21 countries in sub-Saharan Africa conducted between 2006 and 2016. Using subsequent treatment-seeking outcomes, the proportion of MAF and NMFI amongst P. falciparum-positive febrile children presenting at public clinics was estimated. RESULTS: Across all surveyed malaria-positive febrile children who sought care at public clinics across 41 country-years in sub-Saharan Africa, P. falciparum infection was estimated to be the underlying cause of only 37.7% (31.1-45.4, 95% CrI) of P. falciparum-positive fevers, with significant geographical and temporal heterogeneity between surveys. CONCLUSIONS: These findings highlight the complex nature of the P. falciparum burden amongst children under 5 years of age and indicate that for many children presenting at health clinics, a positive P. falciparum diagnosis and a fever does not necessarily mean P. falciparum is the underlying cause of the child's symptoms, and thus other causes of illness should always be investigated, in addition to prescribing an effective anti-malarial medication. In addition to providing new large-scale estimates of malaria-attributable fever prevalence, the results presented here improve comparability between different methods for calculating P. falciparum disease burden, with significant implications for national and global estimation of malaria burden.


Assuntos
Coinfecção/epidemiologia , Efeitos Psicossociais da Doença , Febre/epidemiologia , Malária Falciparum/complicações , África ao Sul do Saara/epidemiologia , Pré-Escolar , Métodos Epidemiológicos , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Prevalência
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