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1.
BMC Health Serv Res ; 22(1): 43, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-34998413

RESUMO

BACKGROUND: Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). METHODS: AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50-74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time. RESULTS: After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23-46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03-77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01-33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38-65.6%] in September 2019. CONCLUSIONS: Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Gerenciamento de Dados , Etiópia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Instalações de Saúde , Humanos , Instalações Privadas
2.
PLoS One ; 16(10): e0257851, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669729

RESUMO

BACKGROUND: Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. METHODS: We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. RESULTS: Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. CONCLUSION: Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.


Assuntos
Infecções Bacterianas/diagnóstico , Diarreia/diagnóstico , Malária/diagnóstico , Pneumonia/diagnóstico , Ampicilina/uso terapêutico , Antimaláricos/uso terapêutico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/terapia , Feminino , Hidratação/normas , Gentamicinas/uso terapêutico , Humanos , Lactente , Recém-Nascido , Malária/epidemiologia , Malária/parasitologia , Malária/terapia , Masculino , Pneumonia/epidemiologia , Pneumonia/microbiologia , Pneumonia/terapia , Instalações Privadas/tendências , Uganda/epidemiologia , Zinco/uso terapêutico
3.
West Afr J Med ; 38(8): 713-718, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34499828

RESUMO

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Nigéria , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Instalações Privadas , Adulto Jovem
4.
Arch Argent Pediatr ; 119(5): 310-316, 2021 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34569738

RESUMO

INTRODUCTION: Health care workers experience a tremendous strain while performing their activities, very frequently leading to stress, burnout syndrome, and psychopathological impact. The COVID-19 pandemic may cause physicians to suffer these effects even to a greater extent. Our objective was to describe the frequency of stress, burnout syndrome, anxiety, and depression during the pandemic, and analyze the associations with different independent outcome measures. METHODS: Observational, cross-sectional study conducted 2 months after the lockdown was established in Argentina. Clinical specialists, surgeons, emergency physicians, and those with no direct contact with patients were surveyed using a sociodemographic questionnaire and 3 self-administered inventories: Health Professions Stress Inventory, Maslach Burnout Inventory, and Hospital Anxiety and Depression Scale. RESULTS: The prevalence of stress was 93.7 % (95 % confidence interval [CI]: 90.33-96.2), burnout syndrome 73.5 % (95 % CI: 68.2-78.4), anxiety 44 % (95 % CI: 38.4-49.8), and depression 21.9 % (95 % CI: 17.3-26.9). No association was observed between the frequency and medical specialty. The frequency of burnout syndrome, anxiety, and depression was significantly higher among residents and physicians working in the emergency department. ConcluSions: Residents and emergency physicians working 24-hour shifts showed significantly higher percentages of burnout syndrome, anxiety, and depression compared to staff and head physicians. These findings may be associated with a higher workload and less experience. It is compulsory to take preventive and therapeutic measures to protect those in the pandemic front line.


Assuntos
Esgotamento Profissional , COVID-19 , Pediatria , Esgotamento Profissional/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Humanos , Pandemias , Instalações Privadas , SARS-CoV-2 , Inquéritos e Questionários
5.
Pan Afr Med J ; 38: 380, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367459

RESUMO

Introduction: this study assessed the availability of family planning (FP) services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya. Social franchises refer to a standardized delivery model of engaging private health facilities under a common brand name or contractual arrangement. Methods: this was a facility-based mixed-method approach. Quantitative data was collected through 581 FP client exit interviews and a facility inventory in 32 health facilities. Association between the clients' characteristics and use of FP services was tested using univariable and multivariable logistic regression. Qualitative data were collected through five focus group discussions with FP clients and 16 key informant interviews with service providers and analysed through thematic analysis. Results: the findings show that FP methods availability was the same across all facilities (p = 0.206). The findings were supported by views from the clients who indicated that contraceptives were available. Statistically significant predictors of FP use were found to be women's age group 20-24 years (Adjusted Odds Ratio (AOR) = 2.30, 95% Confidence Interval (CI): 1.12, 4.69) or 25 to 34 years (AOR = 2.10, 95% CI: 1.86, 2.36) versus the 15-19 years and the clients with tertiary level education and above compared primary level education and below (AOR = 0.020, 95% CI: 1.13, 4.41). Conclusion: this study demonstrates the need to support all private health facilities with policies and supplies to expand access to all FP services, especially for adolescents.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde , Instalações Privadas/estatística & dados numéricos , Adolescente , Adulto , Escolaridade , Feminino , Grupos Focais , Instalações de Saúde/estatística & dados numéricos , Humanos , Quênia , Pessoa de Meia-Idade , Adulto Jovem
6.
Malar J ; 20(1): 250, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34090419

RESUMO

BACKGROUND: Although microscopy remains the gold standard for malaria diagnosis, little is known about its accuracy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. METHODS: Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant's consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant's clinic visit. RESULTS: The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specificity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years' experience in reading malaria smears (adjusted Odds Ratio [aOR] = 9.74, 95% confidence interval [CI] (1.06-89.5), p-value = 0.04), and (2) who was examining less than 5 smears a day (aOR = 38.8, 95% CI 9.65-156, p-value < 0.001). CONCLUSIONS: The accuracy of malaria microscopy in this setting was high, although one third of the patients diagnosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Malária/diagnóstico , Instalações Privadas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Uganda , Adulto Jovem
7.
Arch. argent. pediatr ; 119(5): 310-316, oct. 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1292014

RESUMO

Introducción. A fin de 2019 se identificó una nueva variedad de coronavirus causante de COVID-19 que alcanzó categoría de pandemia. En Argentina, el área metropolitana de Buenos Aires (AMBA) concentra alrededor del 37 % de la población total y el mayor número de casos diagnosticados. El objetivo de este estudio fue describir las características clínico-epidemiológicas de los pacientes con COVID-19 y describir el impacto en el funcionamiento del Servicio de Pediatría de una institución privada de la zona. Métodos. Diseño retrospectivo, observacional, desarrollado en una institución de la zona oeste del AMBA entre el 12 de marzo y el 31 de agosto de 2020. Se incluyeron todos los menores de 16 años con diagnóstico de COVID-19. Se registraron características demográficas, epidemiológicas, clínicas, indicación de internación/control ambulatorio, número de consultas externas, internación por infecciones virales estacionales, licenciamiento del personal, modificación del número de camas y de las actividades de los profesionales. Resultados. Hubo 5454 consultas ambulatorias pediátricas totales, sospecha de COVID-19 en 753/5 454 (13,8 %), se confirmaron 152/753 (20,2 %). Mediana de edad 82 meses (rango intercuartílico: 20,5-147 m), el 50 % fueron varones. La fiebre fue el síntoma más frecuente. Se internaron 22/152 (14,5 %). Las consultas disminuyeron el 87 %, no hubo internación por infecciones virales estacionales y el 52,9 % (91/172) del personal fue licenciado. Conclusiones. La mayoría de los casos fueron leves y la fiebre fue el principal síntoma. Observamos un notable impacto en el funcionamiento del servicio en cuanto al recurso humano. Destacamos la necesidad de la organización logística del servicio para enfrentar esta contingencia.


Introduction. Towards the end of 2019, a novel coronavirus that causes COVID-19 was identified and became a pandemic. In Argentina, approximately 37 % of the total population lives in the Metropolitan Area of Buenos Aires (AMBA), where most cases have been diagnosed. The objective of this study was to describe the clinical and epidemiological characteristics of COVID-19 patients and the impact on the operations of the Department of Pediatrics of a private facility located in the AMBA. Methods. Retrospective, observational study conducted at a facility in the west of AMBA between March 12th and August 31st, 2020. All patients younger than 16 years diagnosed with COVID-19 were included. Demographic, epidemiological, and clinical characteristics; indication for hospitalization/outpatient follow-up; number of outpatient visits; hospitalization due to seasonal viral infections; staff on leave; changes in bed availability and health care providers' activities were recorded. Results. There were 5454 pediatric outpatient visits, COVID-19 was suspected in 753/5454 (13.8 %) and 152/753 (20.2 %) were confirmed cases. Their median age was 82 months (interquartile range: 20.5-147 months); 50 % were males. Fever was the most common symptom. In total, 22/152 (14.5 %) patients were hospitalized. Outpatients visits decreased by 87 %; there were no hospitalizations due to seasonal viral infections; and 52.9 % (91/172) of staff took a leave. Conclusions. Most cases were mild, and fever was the main symptom. The department operations were considerably affected in terms of human resources. It is worth noting the need for a logistic organization at the Department of Pediatrics to face such contingency.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pediatria , Esgotamento Profissional/epidemiologia , COVID-19 , Controle de Doenças Transmissíveis , Inquéritos e Questionários , Estudos Retrospectivos , Pandemias , Instalações Privadas , SARS-CoV-2
8.
Rev Esp Geriatr Gerontol ; 56(4): 208-217, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33892992

RESUMO

PURPOSE: To find out whether elements such as public expenditure, the coverage ratio, public or private ownership, and the size of Nursing homes relate to the number of deaths in residences per COVID-19. MATERIAL AND METHODS: A total of 15 variables are analyzed in 17 Autonomous Communities (n = 17), where the following stand out: public expenditure per dependent person; incidence of COVID-19 in each Autonomous Community; deaths in Nursing homes by COVID-19; and analysis of places in Nursing homes. Reliability of r = 0.613. Regression analyses are carried out with the different variables, and ANOVA tests. RESULTS: Percentages of deaths by COVID-19 in Nursing homes, between 40% and 88%, of the total of (p < 0.001, X2 = 0.975). A relationship is established between the number of deaths from COVID-19 in Nursing homes, and the higher number of private Nursing homes (p < 0.001, X2 = 0.633). The larger the size of the Nursing home, the more deaths by COVID-19 were recorded (p < 0.001, X2 = 0.787), with private Nursing homes having +100 places, and public Nursing homes having +100 places (p < 0.001, X2 = 0.808). CONCLUSIONS: It was found that there is a relationship between the number of deaths from COVID-19 in Nursing homes, and the fact that there are a greater number of private Nursing homes in that autonomous community. It was detected that the model of Nursing home best prepared to face the COVID-19: public Nursing homes with less than 25 places.


Assuntos
COVID-19/mortalidade , Instituição de Longa Permanência para Idosos , Casas de Saúde , Idoso , Gastos em Saúde , Humanos , Incidência , Propriedade , Instalações Privadas , Logradouros Públicos , Espanha
9.
BMC Pregnancy Childbirth ; 21(1): 329, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902472

RESUMO

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.


Assuntos
Entorno do Parto/estatística & dados numéricos , Centros de Assistência à Gravidez e ao Parto , Parto Obstétrico , Serviços de Saúde Materna/organização & administração , Instalações Privadas , Logradouros Públicos , Adulto , Centros de Assistência à Gravidez e ao Parto/economia , Centros de Assistência à Gravidez e ao Parto/normas , Estudos Transversais , Parto Obstétrico/economia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Demografia , Feminino , Acesso aos Serviços de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Instalações Privadas/normas , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Fatores Socioeconômicos , Uganda/epidemiologia
10.
West Afr J Med ; 38(3): 206-212, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33764716

RESUMO

BACKGROUND: There have been calls for privatisation of public health facilities to improve quality of care received. The study compared antenatal and delivery services received in public and private health facilities in Nigeria. METHODS: The study was based on 2018 Nigeria Demographic and Health Survey data collected from women aged 15-49 years, concerning their pregnancy and delivery. Data on those that attended antenatal clinic (ANC) in public or private facilities and had live births in the preceding five years was analysed. Simple logistic regression was used to test for association between type of facility for ANC and delivery and the care received. RESULTS: A total of 15,811 women attended ANC in public (12,921, 81.7%) and private (2,890, 18.3%) facilities, and 12,399 delivered in public (8,583, 69.2%) and private (3,817, 30.8%) facilities. Type of facility attended was associated with number of ANC visits (OR=3.89; p<0.001), blood sample taken (OR=1.16; p=0.029), iron supplementation (OR=0.49; p<0.001), deworming (OR=0.74; p<0.001), receiving all the components of ANC service (OR=0.79; p<0.001), and skilled birth attendance (OR=3.81; p<0.001). However, it was not associated with blood pressure measurement (OR=1.07; p=0.459), urine sample taken (OR=1.05; p=0.486), postnatal check (OR=0.94; p=0.171) and timing of postnatal check (OR=0.73; p=0.185). CONCLUSION: While private facilities had more ANC visits and skilled birth attendance, overall provision of ANC services was better in the public facilities. Therefore, antenatal and delivery services were not necessarily better in private facilities. Beyond availability, further studies are needed to compare the quality of antenatal and delivery services in public and private facilities.


Assuntos
Cuidado Pré-Natal , Instalações Privadas , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria , Gravidez , Adulto Jovem
11.
J Cancer Policy ; 27: 100269, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33520649

RESUMO

The advent of the COVID-19 pandemic has stretched most healthcare systems to the point that if no adaptations are made, failure will most likely happen. The Philippine healthcare system, with its meager resources, is very much vulnerable to this. During the start of the pandemic, Bataan General Hospital and Medical Center has been converted to a COVID-19 hub, leaving cancer care and treatment displaced. We describe our experience in the feasibility of using a religious facility as an interim place for continuing oncology treatment. An outpatient chemotherapy unit was set up using the main hall of the Residencia Sacerdotal, a religious facility, in Bataan. General practices for infection control, workflow and service delivery were in accordance with existing guidelines. A total of 56 adult patients and 22 pediatric patients were seen for chemotherapy during the period of April 28 to July 15, 2020. A total of 144 chemotherapy sessions for adults and 190 sessions for pediatric patients were done. Fifty nine patients (43 adults and 16 pediatric) were tested for COVID-19 RT PCR (GeneXpert®), as baseline prior to chemotherapy, and all were negative. During the course of treatment, adverse events were noted including infusion reactions, hematologic complications which resolved without any complications. No nosocomial infection was recorded both for patients and healthcare workers. To conclude, in the COVID-19 Pandemic Era adapting to the situation is the best way forward. In our setting, continuing cancer care in a religious facility is a feasible alternative.


Assuntos
COVID-19/prevenção & controle , Institutos de Câncer/organização & administração , Neoplasias/terapia , Instalações Privadas/organização & administração , Religião , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Filipinas/epidemiologia , SARS-CoV-2
12.
BMC Health Serv Res ; 21(1): 178, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33632234

RESUMO

BACKGROUND: As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study. METHODS: We used data from 2013 to 14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan's National Health Accounts. The analysis included 7969 encounters from 4293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient). RESULTS: Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region. CONCLUSIONS: This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.


Assuntos
Gastos em Saúde , Instalações Privadas , Utilização de Instalações e Serviços , Humanos , Masculino , Paquistão , Aceitação pelo Paciente de Cuidados de Saúde
13.
BMC Pregnancy Childbirth ; 21(1): 1, 2021 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-33388035

RESUMO

BACKGROUND: Maternal and child health care services are available in both public and private facilities in Nepal. Studies have not yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS). METHODS: Data from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities. RESULTS: The results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR = 3.0, 95% CI = 1.53, 5.91 in 2006; AOR = 5.6, 95% CI = 3.51, 8.81 in 2011; AOR = 6.0, 95% CI = 3.78, 9.52 in 2016). Women from the highest wealth quintile (AOR = 3.3, 95% CI = 1.54, 7.09 in 2006; AOR = 7.3, 95% CI = 3.91, 13.54 in 2011; AOR = 8.3, 95% CI = 3.97, 17.42 in 2016) and women with more years of schooling (AOR = 1.2, 95% CI = 1.17, 1.27 in 2006; AOR = 1.1, 95% CI = 1.04, 1.14 in 2011; AOR = 1.1, 95% CI = 1.07, 1.16 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR = 8.0, 95% CI = 2.43, 26.54 in 2006; AOR = 6.4, 95% CI = 1.59, 25.85 in 2016) were more likely to receive diarrhoea treatment in private health facilities. CONCLUSIONS: Women are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile and more years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.


Assuntos
Pesquisas sobre Serviços de Saúde , Instalações de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Serviços de Saúde Materno-Infantil/tendências , Instalações Privadas/tendências , Adulto , Criança , Intervalos de Confiança , Diarreia/terapia , Escolaridade , Feminino , Comportamentos Relacionados com a Saúde , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Nepal , Razão de Chances , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/estatística & dados numéricos , Logradouros Públicos/tendências , Parcerias Público-Privadas , Classe Social , Fatores de Tempo , Adulto Jovem
14.
Nutr Health ; 27(1): 9-15, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33040682

RESUMO

BACKGROUND: A balanced diet is important for ensuring health and development in childhood. As preschool is the main place of childcare, the meals that they provide have a critical influence on children's dietary intake. AIM: The objectives of this study were to evaluate the nutrition status of preschool meals and to compare the food and nutrient content in public and private preschool meals. METHODS: This was a cross-sectional study of 12 randomly sampled, public and private preschools in Taichung City, Taiwan. The background questionnaires, which included the meal budget and provision status of preschool meals, were completed either by the principals or supervisors of the preschools. The food and nutrition levels of preschool meals were assessed by weighing the actual food provided to the preschool children. In addition, preschool menus were collected to evaluate the meals and food served. RESULTS: Overall, the mean calcium provision of preschools was lower than half the daily dietary reference intake (DRI), and the mean sodium was higher than half the DRI. The mean energy, carbohydrate, protein, fat, iron and vitamins B1, B2 and C supplied by the public preschools were significantly higher than those in the private preschools. In addition, the whole grains, meat, vegetables, fruits, oil and nuts supplied in public preschools were significantly higher than those found in private preschools. CONCLUSIONS: The mean energy and macronutrient provision of public preschools were significantly higher than those found in private preschools. Meal quality and nutrient levels offered in public preschools were generally higher than those found in private preschools.


Assuntos
Serviços de Alimentação , Refeições , Nutrientes , Valor Nutritivo , Instalações Privadas , Logradouros Públicos , Instituições Acadêmicas , Criança , Pré-Escolar , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Masculino , Recomendações Nutricionais , Taiwan
15.
Cult Health Sex ; 23(2): 224-239, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32105189

RESUMO

Globally, access to good quality abortion services and post-abortion care is a critical determinant for women's survival after unsafe abortion. Unsafe abortions account for high levels of maternal death in Kenya. We explored women's experiences and perceptions of their abortion and post-abortion care experiences in Kenya through person-centred care. This qualitative study included focus group discussions and in-depth interviews with women aged 18-35 who received safe abortion services at private clinics. Through thematic analyses of women's testimonies, we identified gaps in the abortion care and person-centred domains which seemed to be important throughout the abortion process. When women received clear communication and personalised comprehensive information on abortion and post-abortion care from their healthcare providers, they reported more positive experiences overall and higher reproductive autonomy. Communication and supportive care were particularly valued during the post-abortion period, as was social support more generally. Further research is needed to design, implement and test the feasibility and acceptability of person-centred abortion care interventions in community and clinical settings with the goal of improving women's abortion experiences and overall reproductive health outcomes.


Assuntos
Aborto Induzido , Instalações Privadas , Feminino , Acesso aos Serviços de Saúde , Humanos , Quênia , Assistência Centrada no Paciente , Gravidez , Pesquisa Qualitativa
16.
BMJ Open ; 10(12): e040398, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33262191

RESUMO

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


Assuntos
Instalações Privadas , Qualidade da Assistência à Saúde , Albânia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde
17.
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
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Infecções por HIV/terapia , Instalações de Saúde/estatística & dados numéricos , Atenção à Saúde/normas , Desinfetantes/provisão & distribuição , Fidelidade a Diretrizes/estatística & dados numéricos , Higienizadores de Mão/provisão & distribuição , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Máscaras/provisão & distribuição , 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
18.
Pan Afr Med J ; 35(Suppl 2): 146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193961

RESUMO

Prevention of exposure to the COVID-19 virus in the general population is an essential strategy to slow community transmission. This paper shares the experiences and challenges of community engagement in COVID-19 prevention in the Kilimanjaro region, Northern Tanzania implemented by our team from the Institute of Public Health (IPH), Kilimanjaro Christian Medical University College (KCMUCo) in collaboration with the COVID-19 response team in the Moshi Municipality. We conducted an education session with the COVID-19 response team and together brainstormed transmission hotspots and which interventions would be most feasible in their settings. The first hotspot identified was crowded local market spaces. Suggested interventions included targeted and mass public health education through the engagement of market opinion leaders, public announcements, and radio shows. We conducted participatory rural appraisal techniques to enable market vendors and clients to visualize two-meter distances and provided a prototype hand-washing facility that was foot operated. We found mass public health educational campaigns essential to inform and update the public about COVID-19 pandemic and to address rumors and misinformation, which hampers compliance with public health interventions. Coordinated efforts among stakeholders in the country are necessary to develop context-specific prevention and case management strategies following the national and international guidelines. Local ownership of recommended interventions is necessary to ensure compliance.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Participação da Comunidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Desinfecção das Mãos/instrumentação , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Humanos , Colaboração Intersetorial , Liderança , Meios de Comunicação de Massa , Aplicativos Móveis , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Instalações Privadas , Saúde Pública , População Rural , SARS-CoV-2 , Participação dos Interessados , Tanzânia/epidemiologia
19.
Toxicol Ind Health ; 36(9): 718-727, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33030104

RESUMO

The reopening of arenas and stadiums following closures due to the 2019 coronavirus disease (COVID-19) pandemic presents unique challenges related to large crowds and close contact between players, vendors, and spectators. While each venue should be assessed individually for development and implementation of reopening plans, the general guidance presented in this document can serve as a minimum baseline for considerations to reduce the risk of COVID-19 transmission in these venues. The intention of these guidelines is to provide a layered approach to risk mitigation for various aspects of particular concern in arenas and stadiums, including crowd management, tailgating and parking, restrooms, high-contact surfaces, face masks, food and merchandising, communications, athletes and support staff, press and third parties, intermissions/breaks, and downtime. The implementation of these multifaceted approaches in each area of concern, along with the integration of regulations and requirements from local, state, and federal government bodies and agencies, will reduce the risk of a single point of failure and offer some protection to those at arenas and stadiums from COVID-19 transmission. The approaches outlined are dynamic and should be regularly reviewed and revised as new information becomes available regarding the transmission of COVID-19.


Assuntos
COVID-19/prevenção & controle , Guias como Assunto , Retorno ao Trabalho , Gestão da Segurança/métodos , Aglomeração , Humanos , Pandemias , Instalações Privadas , Logradouros Públicos , Esportes
20.
Am J Trop Med Hyg ; 103(4): 1681-1690, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32876007

RESUMO

The main objective of this study was to assess the management of childhood infections in high-density poorly planned urban areas of Kampala and Wakiso districts in Uganda, to develop a strategy to deliver integrated community case management (iCCM) of childhood illness services. A total of 72 private healthcare facilities were surveyed (36 drug shops, eight pharmacies, 27 private clinics, and one herbal clinic); supplemented by focus group discussions with village health teams (VHTs), drug shops, and private clinic providers. The majority of drug shops (96.4%, 27/28), pharmacies (100%, 8/8), and (68%, private clinics 17/27) were registered; however, supervision was poor. The majority of patients (> 77%) who visited private health facilities were children aged < 5 years. Furthermore, over 80% (29/64) of the children with uncomplicated malaria were reported to have been given artemether-lumefantrine, and 42% with difficulty breathing were given an antibiotic. Although > 72% providers said they referred children with severe illnesses, taking up referral was complicated by poverty, long distances, and the perception that there were inadequate drugs at referral facilities. Less than 38% of all the facilities had malaria treatment guidelines; < 15% had iCCM guidelines; 6% of the drug shops had iCCM guidelines; and < 13% of the facilities had pneumonia and diarrhea treatment guidelines. Village health teams existed in the study areas, although they had little knowledge on causes and prevention of pneumonia. In conclusion, this study found that quality of care was poor and introduction of iCCM delivered through VHTs, drug shops, and private clinics may, with proper training and support, be a feasible intervention to improve care.


Assuntos
Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Administração de Caso/normas , Pessoal de Saúde/educação , Malária/tratamento farmacológico , Qualidade da Assistência à Saúde , Criança , Redes Comunitárias , Feminino , Humanos , Masculino , Farmácias , Instalações Privadas , Encaminhamento e Consulta , Uganda
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