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1.
Pan Afr Med J ; 38: 35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777303

RESUMO

Introduction: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. Methods: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. Results: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. Conclusion: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Injeções/normas , Atenção Primária à Saúde/normas , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Adulto Jovem
2.
BMC Cancer ; 21(1): 110, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535977

RESUMO

BACKGROUND: Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. METHODS: We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome. RESULTS: There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21-0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28-0.97). CONCLUSION: Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.


Assuntos
Assistência à Saúde , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde Rural/normas , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários , Uganda/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/psicologia , Adulto Jovem
3.
Pan Afr Med J ; 37(Suppl 1): 18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343797

RESUMO

Introduction: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. Methods: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. Results: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. Conclusion: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.


Assuntos
/prevenção & controle , Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/terapia , Instalações de Saúde/estatística & dados numéricos , Assistência à Saúde/normas , Desinfetantes/provisão & distribução , Fidelidade a Diretrizes/estatística & dados numéricos , Higienizadores de Mão/provisão & distribução , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Máscaras/provisão & distribução , Instalações Privadas/normas , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Tanzânia , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricos
4.
Surg Clin North Am ; 100(5): 835-847, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882166

RESUMO

Nearly 60 million people live in a rural area across the United States. Since 2005, 162 rural hospitals have closed, and the rate of rural hospital closures seems to be accelerating. Major drivers of rural hospital closures are poor financial health, aging facilities, and low occupancy rates. Rural hospitals are particularly vulnerable to policy and market changes, and even small changes can have a disproportionate effect on rural hospital financial viability. Surgery can be safely performed in rural hospitals; however, hospital closures may be putting the rural population at increased risk of morbidity and mortality from surgical disease.


Assuntos
Fechamento de Instituições de Saúde/economia , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/economia , Hospitais Rurais/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Previsões , Hospitais Rurais/tendências , Humanos , População Rural , Procedimentos Cirúrgicos Operatórios/tendências , Estados Unidos , Local de Trabalho
5.
Surg Clin North Am ; 100(5): 879-891, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882170

RESUMO

The article describes the barriers rural surgeons face when attempting to measure, analyze, and benchmark the quality and value of the care they provide for their patients. Examples of suboptimal care are presented as well as special geographic and resource-related circumstances for many of these disparities of care. The article includes in-depth descriptions of the American College of Surgeons (ACS) Optimal Resources for Surgical Quality and Safety Program and the ACS Rural Hospital Surgical Verification and Quality Improvement Program. The article concludes by discussing several documented clinical, economic, and social advantages of keeping surgical care local.


Assuntos
Cirurgia Geral/normas , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Melhoria de Qualidade , Estados Unidos
6.
Surg Clin North Am ; 100(5): 901-908, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882172

RESUMO

Several national studies have demonstrated that rural hospitals successfully deliver high-quality care. Data at the national, regional, institutional, and individual practitioner levels all contribute to understanding of surgical outcomes in the rural setting. Quality metrics should be interpreted within the context of the rural community and outcomes analyzed with relevant risk adjustment for patient factors.


Assuntos
Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/normas , Política de Saúde , Humanos , Estados Unidos
7.
Obstet Gynecol ; 136(4): 739-744, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925622

RESUMO

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.


Assuntos
Ginecologia , Acesso aos Serviços de Saúde , Obstetrícia , Melhoria de Qualidade/organização & administração , Serviços de Saúde da Mulher , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/etnologia , Humanos , Índios Norte-Americanos , Colaboração Intersetorial , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Estados Unidos/epidemiologia , Serviços Urbanos de Saúde/normas , Populações Vulneráveis/etnologia , Serviços de Saúde da Mulher/organização & administração , Serviços de Saúde da Mulher/normas , Serviços de Saúde da Mulher/tendências
8.
BMC Health Serv Res ; 20(1): 372, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366235

RESUMO

BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.


Assuntos
Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços Urbanos de Saúde/normas , Idoso , China , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
9.
PLoS One ; 15(3): e0230121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203556

RESUMO

BACKGROUND: People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration's Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. METHODS AND FINDINGS: Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service ("RWHAP providers") were categorized as rural or non-rural according to the HRSA FORHP's definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as "visited only rural providers," "visited only non-rural providers," or "visited rural and non-rural providers." In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1-99 clients, while 29.6% of non-rural providers served 1-99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. CONCLUSIONS: RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.


Assuntos
Assistência à Saúde/normas , Infecções por HIV/terapia , Acesso aos Serviços de Saúde , Patient Protection and Affordable Care Act/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , United States Health Resources and Services Administration/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Administração Financeira , Geografia , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/organização & administração , Patient Protection and Affordable Care Act/normas , Características de Residência , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/normas , Pessoas Transgênero , Resultado do Tratamento , Estados Unidos/epidemiologia , United States Health Resources and Services Administration/organização & administração , United States Health Resources and Services Administration/normas , Adulto Jovem
13.
Res Nurs Health ; 43(1): 122-133, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793678

RESUMO

Community-based home visiting programs using community health workers (CHWs) have become popular modes of delivering health care services, especially in settings where health workers are overburdened and resources are limited. Yet, little is known about the processes that shape effective implementation in low-resource settings, and whether these processes adhere to home visitors' training. This study used the newly-developed Home Visit Communication Skills Inventory (HCSI) to explore the delivery of a CHW program in rural South Africa. Routine home visits from CHWs to their maternal care clients were audio-recorded with consent, and later transcribed and translated into English. The HCSI, devised and piloted using existing frameworks and program-specific training components, consisted of 21 items covering domains related to active listening, active delivery, and active connecting, and was used to score English transcripts of the home visits. The HCSI was used to generate general frequencies and aggregate scores for each CHW. Eighty-four home visits by 14 CHWs showed a diverse application of communication skills. Active listening and active delivery were common, with fewer instances of active connecting observed. Practices disaggregated by CHW showcased varying strengths by an individual. In reviewing visit characteristics, longer average visit duration was significantly correlated with the presence of multiple types of active connecting skills. While technical skills were widely observed, fewer CHWs engaged in more complex "connecting" skills. The HCSI is a feasible, low-cost, and practical way to describe home visit fidelity among CHWs. Audio-based checklists can be used to describe fidelity to a model in the absence of additional supervisory resources.


Assuntos
Comunicação , Agentes Comunitários de Saúde/normas , Visita Domiciliar , Relações Enfermeiro-Paciente , Cuidado Pós-Natal/normas , Guias de Prática Clínica como Assunto , Serviços de Saúde Rural/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , África do Sul
14.
Int J Nurs Stud ; 101: 103401, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670221

RESUMO

BACKGROUND: Cancer is a major public health problem worldwide. The GLOBOCAN estimated 18.1 million new cases of cancer and 9.6 million deaths from cancer in 2018. In some of the more frequent cancers, mortality can be significantly reduced through cancer screening programs. Nevertheless, socially disadvantaged groups have difficulties in benefitting from these screening programs, especially rural populations. OBJECTIVE: To identify, characterize and summarize patient-targeted interventions aimed at increasing cancer screening participation among rural populations. METHODS: An exhaustive literature search was performed in the most relevant bibliographic databases for biomedical research. The systematic review was reported according to the PRISMA guidelines. RESULTS: Twenty studies assessing 37 interventions were identified. Most of the studies were conducted in the United States and targeted women. Ninety-seven percent of the interventions were aimed at increasing community demand, 65% community access and 11% provider delivery. Our findings suggest that 21 of the 37 interventions using a multicomponent approach were effective in increasing breast, cervical and colorectal cancer screening in rural areas. CONCLUSIONS: Multicomponent interventions were effective in increasing breast, cervical and colorectal cancer screening among rural populations, and nurse-led interventions contributed to improving cancer screening participation. Moreover, the involvement of communities in the development of interventions can facilitate the participation in cancer screening programs among rural residents.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Neoplasias/diagnóstico , Serviços de Saúde Rural/organização & administração , População Rural , Humanos , Programas de Rastreamento/psicologia , Motivação , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/normas
15.
J Trauma Acute Care Surg ; 88(1): 148-152, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31389917

RESUMO

BACKGROUND: Early administration of plasma improves mortality in massively transfused patients, but the thawing process causes delay. Small rural centers have been reluctant to maintain thawed plasma due to waste concerns. Our 254-bed rural Level II trauma center initiated a protocol allowing continuous access to thawed plasma, and we hypothesized its implementation would not increase waste or cost. METHODS: Two units of thawed plasma are continuously maintained in the trauma bay blood refrigerator. After 3 days, these units are replaced with freshly thawed plasma and returned to the blood bank for utilization prior to their 5-day expiration date. The blood bank monitors and rotates the plasma. Only trauma surgeons can use the plasma stored in the trauma bay. Wasted units and cost were measured over a 12-month period and compared with the previous 2 years. RESULTS: The blood bank thawed 1127 units of plasma during the study period assigning 274 to the trauma bay. When compared with previous years, we found a significant increase in waste (p < 0.001) and cost (p = 0.020) after implementing our protocol. It cost approximately US $125/month extra to maintain continuous access to thawed plasma during the study period. DISCUSSION: A protocol to maintain thawed plasma in the trauma bay at a rural Level II trauma center resulted in a miniscule increase in waste and cost when considering the scope of maintaining a trauma center. We think this cost is also minimal when compared with the value of having immediate access to thawed plasma. Constant availability of thawed plasma can be offered at smaller rural centers without a meaningful impact on cost. LEVEL OF EVIDENCE: Economic and Value-based Evaluations, Level III.


Assuntos
Transfusão de Componentes Sanguíneos/métodos , Protocolos Clínicos/normas , Hemorragia/terapia , Plasma , Serviços de Saúde Rural/organização & administração , Centros de Traumatologia/organização & administração , Bancos de Sangue/economia , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Bancos de Sangue/estatística & dados numéricos , Transfusão de Componentes Sanguíneos/economia , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/estatística & dados numéricos , Hemorragia/etiologia , Humanos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/economia , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos
16.
Pan Afr Med J ; 37: 313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33654532

RESUMO

Introduction: inspite of the demonstrable evidence of the preventive and protective ability of vaccines to reduce the outbreak of vaccine-preventable diseases, there are still some significant disease outbreaks recorded in our communities. In some settings, these outbreaks have been linked with poor vaccine management. Therefore, this study was conducted to compare the cold chain practices in Oyo State, Nigeria. Methods: we conducted a cross-sectional survey among health workers in the local government areas of Oyo State between October and November 2019. Using purposive sampling, we recruited all the 84 routine immunization focal persons for the study. A self-administered questionnaire was used to collect data on cold chain management. Data were analyzed using SPSS version 24 and bivariate analysis was done using Chi-square. Statistical significance was set at p < 0.05. Results: the mean age of the respondents was 46.4 ± 6.7 years. Most prevalent cadre in the rural facilities was health assistants (87.5%) while Community Extension Health Workers (54.8%) were prevalent in the urban (p = 0.002). The proportion of respondents with adequate cold chain equipment was significantly higher in the urban compared with the rural area. The cold boxes were the only adequate cold chain equipment found in the rural health facilities compared with the urban (p = 0.036). Conclusion: there was a low proportion of qualified health workers and inadequate cold chain equipment in the rural area compared with the urban facilities. Engagement of skilled health workers and supply of the cold chain equipment are recommended.


Assuntos
Poliomielite/prevenção & controle , Vacinas contra Poliovirus/administração & dosagem , Poliovirus/imunologia , Refrigeração/normas , Adulto , Estudos Transversais , Surtos de Doenças , Armazenamento de Medicamentos/normas , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Poliomielite/epidemiologia , Vacinas contra Poliovirus/imunologia , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Vacinação/normas
17.
J Foot Ankle Res ; 12: 56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827623

RESUMO

Background: There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. Methods: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. Results: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86). Conclusions: A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Pé Diabético/etiologia , Podiatria/economia , População Rural/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/mortalidade , Pé Diabético/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/epidemiologia , Podiatria/normas , Prevalência , Estudos Prospectivos , Fatores de Risco , Serviços de Saúde Rural/normas , População Rural/tendências , Fatores Socioeconômicos , Tasmânia/epidemiologia , Vitória/epidemiologia
18.
J Health Popul Nutr ; 38(1): 41, 2019 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-31810496

RESUMO

BACKGROUND: World Health Organization revised the global guidelines for management of possible serious bacterial infection (PSBI) in young infants to recommend the use of simplified antibiotic therapy in settings where access to hospital care is not possible. The Bangladesh Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GOB) adopted these guidelines, allowing treatment at first-level facilities. During the first year of implementation, the Projahnmo Study Group and USAID/MaMoni Health Systems Strengthening (HSS) Project supported the MoHFW to operationalize the new guidelines and conducted an implementation research study in selected districts to assess challenges and identify solutions to facilitate scale-up across the country. IMPLEMENTATION SUPPORT: Projahnmo and MaMoni HSS teams supported implementation in three areas: building capacity, strengthening service delivery, and mobilizing communities. Capacity building focused on training paramedics to conduct outpatient management of PSBI cases and developing monitoring and supervision systems. The teams also filled gaps in government supply of essential drugs, equipment, and logistics. Community mobilization strategies to promote care-seeking and referrals to facilities varied across districts; in one district community, health workers made home visits while in another district, the promotion was carried out through community volunteers, village doctors, and through existing community structures. METHODS: We followed a plan-do-study-act (PDSA) cycle to identify and address implementation challenges. Three cycles-1 every 4 months-were conducted. We collected data utilizing quantitative and qualitative methods in both the community and facilities. The total sample size for this study was 13,590. DISCUSSION: This article provides implementation research design details for program managers intending to implement new guidelines on management of young infant infections. Results of this research will be reported in the forthcoming papers. Preliminary findings indicate that the management of PSBI cases at the UH&FWCs is feasible. However, MoHFW, GOB needs to address the implementation challenges before scale-up of this policy to the national level.


Assuntos
Infecções Bacterianas/terapia , Fortalecimento Institucional/métodos , Programas Governamentais/métodos , Implementação de Plano de Saúde/métodos , Ciência da Implementação , Antibacterianos/normas , Bangladesh , Feminino , Humanos , Lactente , Bem-Estar do Lactente , Recém-Nascido , Masculino , Projetos de Pesquisa , Serviços de Saúde Rural/normas , População Rural
19.
BMC Health Serv Res ; 19(1): 848, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747932

RESUMO

BACKGROUND: Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. METHODS: Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. RESULTS: The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. CONCLUSION: Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.


Assuntos
Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Feminino , Instalações de Saúde/normas , Pessoal de Saúde/normas , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/normas , Serviços de Saúde Rural/normas , Tanzânia , Cobertura Universal do Seguro de Saúde/organização & administração , Adulto Jovem
20.
Rural Remote Health ; 19(4): 5348, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31721594

RESUMO

CONTEXT: Klippel-Trénaunay syndrome (KTS) is a very rare congenital vascular anomaly. It is characterized by the presence of capillary malformation, venous malformation as well as limb overgrowth, generally affecting one extremity. Although clinical characteristics of KTS are well known, the epidemiology and pathophysiology still remain to be defined. Awareness of these disorders is important for rural physicians for managing potential complications. ISSUE: A 60-year-old male presented with symptomatic varicosities and chronic venous insufficiency of the left leg. The patient had a history of several episodes of ulceration and thrombophlebitis on the left side. Physical examination revealed extensive varicosities and a large port-wine stain on the lateral side of the left leg, despite a previous ligation of the saphenofemoral junction. The left leg was circumferentially larger than the right leg. Additional investigations were conducted to rule out arterial disorders and confirm the venous nature of the abnormalities. The patient was clinically diagnosed with KTS and his varicosities were treated surgically using phlebectomy with stab avulsion technique. LESSONS LEARNED: KTS is a distinct entity that belongs to the vascular malformations group. In a rural practice, identification and accurate diagnosis are challenging, as these patients often require a multidisciplinary approach and do not present until later in the course of the condition. An understanding of the correct nomenclature and associated complications is imperative for proper assessment and management in rural and remote settings.


Assuntos
Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/tratamento farmacológico , Síndrome de Klippel-Trenaunay-Weber/fisiopatologia , Guias de Prática Clínica como Assunto , Serviços de Saúde Rural/normas , Humanos , Masculino , Pessoa de Meia-Idade , Terra Nova e Labrador , Doenças Raras/diagnóstico , Doenças Raras/tratamento farmacológico , Resultado do Tratamento
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