Cracking the code of health security: unveiling the balanced indices through rank-ordered effect analysis.

BACKGROUND: Health security is a critical issue which involves multiple dimensions. It has received increasing attention in recent years, especially in China. In order to improve the national health level, China has made many efforts, such as the "Healthy China 2030" plan proposed several years ago. However, due to the complexity of its national conditions and the difficulty of index design, the results of these efforts are not significant. Therefore, it is necessary to construct a new measurement index system. METHODS: Based on the questionnaire of "Health China 2030", we have collected a total of 3,000 participants from all 31 provinces, autonomous regions, and municipalities in China. We used statistical methods such as multiple correspondence analysis and rank-ordered effect analysis to process the data. The balance index is constructed by a series of actions such as weight division, order calculation and ranking. RESULTS: Through multiple correspondence analysis, we can find that there was a close relation in the correspondence space between the satisfaction degrees 1, 2, and 3, while a far distance from satisfaction degrees 4 and 5. There were four positive and four negative indices separately based on the average expected level and four clusters after ordinal rank cluster analysis. Generally speaking, there are no prominent discrepancies across gender and residential areas. CONCLUSIONS: We created and examined balanced indicators for health security in China based on the "Health China 2030" questionnaire. The findings of this study give insight into the overall situation of health security in China and indicate opportunities for improvement.

The Future of Public Health: Ensuring An Adequate Infrastructure.

Policy Points The US public heath infrastructure is in disrepair and building a sustainable system is the central challenge for the nation. Doing so in a highly patrician environment is the mission for the next ten years.

European Society of Cardiology: cardiovascular disease statistics 2021.

AIMS: This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. METHODS AND RESULTS: Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. CONCLUSION: Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.

An inter-district analysis of health infrastructure disparities in the Union Territory of Jammu and Kashmir.

Achieving socioeconomic growth can be done by enhancing national health. The availability and provision of health infrastructure in an administrative territory affect the health of ordinary people. People's access to healthcare is inversely correlated with the availability of a region's health infrastructure. This study investigates inter-district health infrastructure disparities in the newly created Union Territory (UT) of Jammu and Kashmir. Using principal component analysis, this study developed a district-level health infrastructure index (HII) for 2018-2019. The study demonstrates the existence of inter-district disparities in the Union Territory's health infrastructure. Regarding health infrastructure, Doda has the highest HII and has been designated a 'developed' district. Doda is followed by Jammu, Kishtwar, Udhampur, Ramban, Samba, Reasi and Kulgam, which also fall into the 'developed' districts category. Backward districts include Kathua, Rajouri, Poonch, Budgam, Shopian, Kupwara, Ganderbal, Baramulla, Bandipora, and Anantnag. Srinagar district, with the lowest HII, was identified as the most backward district in the Jammu and Kashmir UT. All of the districts of the Kashmir division, apart from Kulgam, are classified as being 'backward' or 'very backward'. Therefore, it is evident that the Jammu division of UT has a better health infrastructure than the Kashmir division.

Leveraging COVID-19 pandemic response for improved health system financing: Lessons from Ghana.

The COVID-19 pandemic has exposed health system funding challenges across many developing countries. The needed infrastructure to effectively respond to the pandemic was absent in many developing countries. This has resulted in policymakers resorting to various strategies to mobilise sufficient resources in response to the pandemic, especially in the early stages. This paper reviewed Ghana's efforts to mobilise domestic and external resources for the health sector in response to the pandemic. The paper also assessed lessons from these strategies and highlights how these lessons could be leveraged to sustain financing for the health sector. Using evidence from desk reviews, we demonstrate the existence of fiscal space through external sources, partnership with non-state actors, and effective public financial management (budget space). We also show that the COVID-19 pandemic presents an important momentum to drive future investment in health infrastructure across developing countries.

Integrating health planning and primary care infrastructure for COVID-19 and tuberculosis care in India: Challenges and opportunities.

Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The COVID-19 pandemic has overburdened healthcare services around the world especially in resource constrained settings. It has shaken already unstable foundation of TB control programs in India and other high burden states. A 25% decline is expected in TB detection while estimates suggest 13% increase in TB deaths due to the impact of the pandemic. However, the significant intersections between the two diseases perhaps offer potential opportunities for consolidating the efforts to tackle both. The widespread implementation and acceptance of universal masking and social distancing in India has helped limit transmission of both diseases. Integrating the capacity building strategies for the two diseases, optimizing the existing the surveillance and monitoring systems which have been achieved over the years will result in a single vertically integrated national program addressing both, rather than multiple parallel program which utilize the already sparse primary care manpower and infrastructure. In this article, we explore the impact of the COVID-19 pandemic on tuberculosis in India and offer suggestions on how effective health planning can efficiently integrate infrastructure and manpower at primary level to provide care for both COVID-19 and tuberculosis.

School Health Infrastructure and Students' Elevated Body Mass Index.

School-age children with overweight or obesity continue to be problematic in the United States, and are associated with many health, social, and financial problems. Schools provide an excellent venue in which to promote healthy weight in students, and school nurses are well-positioned to play an essential role in controlling obesity. The number of studies reporting relationships among school health infrastructure and prevalence of elevated Body Mass Index (BMI) is limited. The present study explored associations between three components of school health infrastructure (staff, services, budget) and the proportion overweight or obese 1st, 3rd, and 6th grade students, after controlling for selected factors (race, county education level, county poverty level, rurality). Study results supported an independent association between elevated BMI and school health staff. Additionally, independent associations between elevated BMI and the following covariates were supported: household income, race, and parents' educational level. There is an ultimate need for well-designed studies addressing these associations.

Does health financial resource correlate with physical health infrastructure?

Background: Is building physical health infrastructure (PHI) a priority for state governments within the northeastern states (NES) of India? The decentralization mechanism initiated by the government of India to synergize health care across states seems highly unequal. Certain Indian states such as Kerala, Uttarakhand, and Himachal Pradesh have achieved phenomenal progress in the health-care system through a decentralized mechanism. Objectives: The study attempts to examine the PHI of NES and public health resources. Methods: The study has employed the Euclidian Distant Method (EDM) which fulfills various compulsive and instinctive properties; specifically, normalization, symmetry, monotonicity, proximity, uniformity, and signaling inclusively. This method ranks the states in terms of infrastructure availability and public health resources. Second, the correlation was done to see the relationship between the PHI of NES and public health resources. Results: The results of the EDM show that Arunachal Pradesh ranked the highest in the Index of Public Health Infrastructure, whereas Assam ranked the lowest. The Index of Public Health Resource shows interesting results. Assam has remained at the lowest rank and inconsistency of ranks among the other NES. The correlation between the indices is positive, yet not encouraging. Conclusion: This implies that building up health infrastructure and responding to the demand for health-care infrastructure still stands ignored and rather remained stagnant.

Impact of social accountability monitoring on health facility performance: Evidence from Tanzania.

Social accountability programs are increasingly used to improve the performance of public service providers in low-income settings. Despite their growing popularity, evidence on the effectiveness of social accountability programs remains mixed. In this manuscript, we assess the impact of a social accountability intervention on health facility management exploring quasiexperimental variation in program exposure in Tanzania. We find that the social accountability intervention resulted in a 1.8 SD reduction in drug stockouts relative to the control group, but did not improve facility infrastructure maintenance. The results of this study suggest that social accountability programs may be effective in areas of health service provision that are responsive to changes in provider behavior but may not work in settings where improvements in outcomes are conditional on larger health systems features.

Maternal Health Infrastructure and Interpersonal Quality of Care During Childbirth: An Examination of Facility Delivery in Malawi.

OBJECTIVES: The maternal health field has recently focused on the importance of interpersonal quality of care and continues to cite structural deficits as a contributor to poor interpersonal treatment. This hypothesis is supported by qualitative evidence. This study quantitatively tested the effect of maternal health structural inputs on interpersonal quality of care during childbirth. METHODS: Analyses were conducted using data from the 2013 to 2014 Malawi Service Provision Assessment, which documented the availability and quality of health facility services and included the observation of laboring and delivering women. Maternal health structural inputs were measured using 26 facility infrastructure variables. The outcome, interpersonal quality of care, was measured as a sum score of 12 items collected during the observations. Crude and adjusted associations between maternal health structural inputs on interpersonal quality of care were assessed using linear regression with cluster robust standard errors. RESULTS: 345 Observations of delivering women in 174 health facilities were included in the analysis. 19.1% of women delivered in a facility with high maternal health structural inputs, and the mean interpersonal quality of care score was 8.9/12. Maternal health structural inputs had a small, non-meaningful association with interpersonal quality of care during childbirth (adjusted ß - 0.19, 95% CI - 0.85, 0.47). CONCLUSIONS FOR PRACTICE: These findings do not verify the quality of care frameworks or qualitative evidence that support the relationship between structure and interpersonal quality of care. While structural inputs are important for health system performance, the results suggest that they might not be necessary for a respectful childbirth experience.

European Society of Cardiology: Cardiovascular Disease Statistics 2019.

AIMS: The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. METHODS AND RESULTS: In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5-23.1%] vs. 15.7% (IQR 14.5-21.1%)}, diabetes [7.7% (IQR 7.1-10.1%) vs. 5.6% (IQR 4.8-7.0%)], and among males smoking [43.8% (IQR 37.4-48.0%) vs. 26.0% (IQR 20.9-31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0-10.8) vs. 16.7% (IQR 13.9-19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655-8115)] compared with high-income [2235 (IQR 1896-3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. CONCLUSION: A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

[Mental health care needs and use of services in Mexican population with serious mental disorders]. / Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves.

OBJECTIVE: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychi- atric hospital. RESULTS: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (ß=1.062, p=.000), family income (ß=1.000, p=.000) and no laboral occupation (ß=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (ß=4.158, p=.000). CONCLUSIONS: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

OBJETIVO: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. RESULTADOS: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (ß=1.062; p=.000), ingreso familiar (ß=1.000, p=.000) y no tener ocupación (ß=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (ß=4.158; p=.000). CONCLUSIONES: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

How far is the journey before malaria is knocked out of Zimbabwe? (or Africa): a commentary.

Recent publications and statements have drawn attention to a sustainable system of managing malaria control interventions globally but especially on the Continent of Africa. Arbitrary and unstable governments often interfere with health programmes, causing upsurges in malaria transmission as well as other health issues. A well-run health infrastructure will deal with public health as a whole. This commentary follows historical conditions in Zimbabwe where much original work on malaria control was initiated and implemented and where unstable conditions happened through local politics. These periodic conditions of instability on the ground challenge the current philosophical thrust to eradication and stress the need and role of an established and well-staffed health infrastructure in each country. Such facilities should be well staffed and supplied with drugs and point-of care diagnostic tests to manage malaria and should be sustained to serve the community even after tools that can eradicate malaria are developed.

European Society of Cardiology: Cardiovascular Disease Statistics 2017.

Aims: The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high-income and middle-income ESC member countries to identify inequalities in disease burden, outcomes, and service provision. Methods and results: The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence, and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC-sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Important differences were identified between the high-income and middle-income member countries of the ESC with regard to CVD risk factors, disease incidence, and mortality. For both women and men, the age-standardized prevalence of hypertension was lower in high-income countries (18% and 27%) compared with middle-income countries (24% and 30%). Smoking prevalence in men (not women) was also lower (26% vs. 41%) and together these inequalities are likely to have contributed to the higher CVD mortality in middle-income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high-income member countries, but in middle-income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasized by the smaller contribution they make to potential years of life lost in high-income countries compared with middle-income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all the ESC member countries. Survey data from the National Cardiac Societies showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high-income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular health care, as some middle-income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion: In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, health care delivery, and outcomes of CVD across the ESC member countries. The availability of these data will underpin the ESC's ambitious mission 'to reduce the burden of cardiovascular disease' not only in its member countries but also in nation states around the world.

Developing Equitable Primary Health Care in Conflict-Affected Settings: Expert Perspectives From the Frontlines.

Health systems are frequently among the casualties of conflict. Within these settings, increased knowledge is needed on how to rebuild and strengthen health infrastructure resilience, such as primary health care (PHC) systems, in context-specific ways that promote health equity. Therefore, this study aimed to explore perspectives of experts with experience working on frontlines of social crises to contribute to understandings of pathways toward equitable PHC in conflict-affected settings. Semistructured qualitative interviews with 18 expert participants were completed. Through engaging elements of grounded theory situational analysis, three themes emerged iteratively, including (a) Building Blocks, (b) Intermediating Factors, and (c) a Roadmap. These emergent themes contribute to conceptual frameworks explaining key contextually specific priorities, challenges, and facilitating factors for developing resilient health infrastructures under social crises. Findings inform policy and practical guidelines that address complexities of conflict conditions and underscore the importance of PHC development toward promoting health as a human right.

Analyzing the impact of severe tropical cyclone Yasi on public health infrastructure and the management of noncommunicable diseases.

INTRODUCTION: Traditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a "disease transition" is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly. Problem There is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems. METHODS: A literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises. RESULTS: This research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced were linked closely. These relate to communication, equipment and services, evacuation, medication, planning, and water supplies. CONCLUSION: This research demonstrated that a negative trend pattern existed between the impact of STC Yasi and other similar world cyclone events on PHI and the management of NCDs. This research provides an insight for disaster planners to address concerns of people with NCDs. While further research is needed, this study provides an understanding of areas for improvement, specifically enhancing protective PHI and the development of strategies for maintaining treatment and alternative care options, such as maintaining safe water for dialysis patients.

Sub-Saharan African experience of neurosurgical oncology care: challenges and barriers encountered at 7 cancer treatment centers.

OBJECTIVE: Wide disparities in neurosurgical oncology care and treatment outcomes exist globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical oncology care in low-resource settings, the authors collected data on national neurosurgical capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries in sub-Saharan Africa (SSA). METHODS: In April 2023, a 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 centers via REDCap to provide country- and hospital-level capacity data on neurosurgical oncology care. RESULTS: Neurosurgical and neurosurgical oncology care were reported to be available in a limited number of provinces, states, regions, and counties in 6 of the 7 countries. The general neurosurgical workforce density across the 7 countries ranged from 0.03 to 0.67 per 100,000 persons, and that of the pediatric neurosurgical workforce ranged from 0 to 0.05 per 100,000 persons. Two centers had no pediatric ICUs, and the remaining 5 centers had pediatric ICUs with bed capacities between 1 and 8. One hospital had neither a CT nor an MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic histopathology staining only; molecular subtyping was available at a single center. Three hospitals offered pediatric anesthesia expertise. None of the hospitals offered subspecialty neuro-oncology care or had a pediatric neuro-oncologist. None of the 7 hospitals had formal neurocritical care, neuroradiology, or neuropathology expertise. Neither adjuvant chemotherapy nor radiotherapy was available at 3 centers. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 centers. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical oncology services, with patients making out-of-pocket payments for all services in some cases. CONCLUSIONS: There are significant challenges to timely and quality neurosurgical oncology care in SSA especially for children. System-level interventions are needed to strengthen neurosurgical oncology care capacity in SSA.

The emergence of telemedicine in a low-middle-income country: challenges and opportunities.

The quality of cancer care delivery varies across different regions of Ghana, highlighting the need for improved access to quality healthcare services. Telemedicine has emerged as a promising solution to address this disparity, as it can reduce costs and improve access to healthcare services for cancer patients in remote areas. Despite the widely reported benefits of telemedicine, its adoption in low-resource settings has been slow due to several challenges. This study explores strategies for incorporating telemedicine into the current healthcare system in Ghana for the benefit of all patients especially those diagnosed with cancer. The study also highlights the current challenges and opportunities associated with the implementation and utilisation of telemedicine in Ghana. This research was a cross-sectional study conducted in Accra, Ghana that adopted a mixed-methods approach. Participants were selected through multi-stage probability sampling. Quantitative data were collected via a survey whereas qualitative data were obtained by means of in-depth interviews and focus group discussions among healthcare professionals, patients and key stakeholders in the telemedicine industry. The Statistical Program for the Social Sciences (version 21) was used to assemble, analyse and display the research data. The major challenges discussed centered on high initial investment costs, privacy and security concerns, poor internet connectivity, insufficient infrastructure and training of healthcare providers as well as the resistance to change among healthcare professionals. The study contributes to the understanding of telemedicine adoption in Ghana with findings underscoring the potential to address healthcare challenges while highlighting the need to overcome implementation obstacles. The study findings also provide valuable insights for policymakers, healthcare institutions and stakeholders to enhance telemedicine adoption in Ghana.

Enhancing assessment and treatment of hepatitis C in the custodial setting.

Acute and chronic hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. This disparity between the burden of disease and hepatitis service delivery reflects the marginalized patient population, which features high rates of injection drug use and poor mental health. In addition, the prison environment is intended for deprivation of liberty and not healthcare. Screening for HCV infections is provided in most jurisdictions, but uptake rates remain low. Assessment and treatment of inmates is often provided only by community-based services. Despite these challenges, assessment and treatment of inmates with chronic HCV via prison-based services has been shown to be feasible and effective. These services offer the potential to substantively increase HCV treatment uptake and reduce the burden of disease for the community at large. Improvements in the efficacy of HCV therapies via direct-acting antivirals, which also offer reduced treatment duration and decreased toxicities, mean that prison health services will be well placed for the treatment of large numbers of people with HCV who do not access health services in the community.

Impact of Armed Conflicts on Public Health Infrastructure and Services in Oromia, Ethiopia.

Background Oromia is the largest national regional state in the Ethiopian federation. It covers over a third of the country's landmass. In terms of sheer geography, Oromia is about the size of the sovereign European state of Germany. Demographically, Oromia closely matches with Poland among other European countries. Since early 2019, there are actively ongoing armed conflicts in Oromia damaging the public health infrastructure and hampering the provision of healthcare services. Objective The objective of this study is to assess and document the impacts of armed conflicts in Oromia on the public health infrastructure. Method The study is a quantitative review of administrative records and reports employing a qualitative analytical prism. Results Oromia has 22 administrative zones of which 11 (50%) host 142 sites sheltering about 1.5 million Internally Displaced Persons (IDPs). A total of 1072 public healthcare facilities sustained attacks in areas of armed conflicts across Oromia. Among the 159 motor vehicles attacked (ambulances, district health office cars and motorbikes), 44% were ambulances. Only for the first two weeks of January 2023, 25,580 Severe Acute Malnutrition (SAM) cases were reported by healthcare facilities from the areas affected by armed conflicts in Oromia. In these areas, 11,740 patients with malnutrition were enrolled into the Outpatient Therapeutic Program (OTP), 1050 were put on subcutaneous infusion (SC) and seven died due to SAM only in the first two weeks of January 2023. Severe droughts that happened for five consecutive rainy seasons over the last three years have hit hard 10 administrative zones in Oromia, thereby compounding the impacts of the armed conflicts. Conclusions Armed conflicts are damaging the public health infrastructure and hampering healthcare provisions in Oromia. Such conflicts are evicting people from their residential places thereby forcing them to live in poorly thatched out temporary shelters with clear implication for serious health crises. When compounded with natural calamities such as climate-change-driven drought, the impacts of such conflicts on public health infrastructure and the resultant constraints on provision of vital public healthcare services would be paramount. The authors recommend for further detailed studies on the sustained impacts that these armed conflicts can possibly bring on the provision of vital public health services in Oromia.