Experimental validation of an electrical and thermal energy demand model for rapid assessment of rural health centers in sub-Saharan Africa

Abstract Introduction Institutional delivery is a major concern for a country’s long-term growth. Rapid population development, analphabetism, big families, and a wider range of urban-rural health facilities have had a negative impact on institutional services in Sub-Saharan Africa (SSA) countries. The aim of this study was to look into the factors that influence women’s decision to use an institutional delivery service in SSA. Methods The most recent Demographic and Health Survey (DHS), which was conducted in nine countries (Senegal, Ethiopia, Malawi, Rwanda, Tanzania, Zambia, Namibia, Ghana, the Democratic Republic of Congo) was used. The service’s distribution outcome (home delivery or institutional delivery) was used as an outcome predictor. Logistic regression models were used to determine the combination of delivery chances and different covariates. Results The odds ratio of the experience of institutional delivery for women living in rural areas vs urban area was 0.44 (95% confidence interval (CI) 0.41–0.48). Primary educated women were 1.98 (95% CI 1.85–2.12) times more likely to deliver in health institutes than non-educated women, and secondary and higher educated women were 3.17 (95% CI 2.88–3.50) times more likely to deliver in health centers with facilities. Women aged 35–49 years were 1.17 (95% CI 1.05–1.29) times more likely than women aged under 24 years to give birth in health centers. The number of ANC visits: women who visited four or more times were 2.98 (95% CI 2.77–3.22) times, while women who visited three or less times were twice (OR = 2.03; 95% CI 1.88–2.18) more likely to deliver in health institutes. Distance from home to health facility were 1.18 (95% CI 1.11–1.25) times; media exposure had 1.28 (95% CI 1.20–1.36) times more likely than non-media-exposed women to delivery in health institutions. Conclusions Women over 24, primary education at least, urban residents, fewer children, never married (living alone), higher number of prenatal care visits, higher economic level, have a possibility of mass-media exposure and live with educated husbands are more likely to provide health care in institutions. Additionally, the distance from home to a health facility is not observed widely as a problem in the preference of place of child delivery. Therefore, due attention needs to be given to address the challenges related to narrowing the gap of urban-rural health facilities, educational level of women improvement, increasing the number of health facilities, and create awareness on the advantage of visiting and giving birth in health facilities.

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Exploring country-wide equitable government health care facility access in Uganda

International Journal for Equity in Health ◽

10.1186/s12939-020-01371-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nicholas Dowhaniuk

Keyword(s):

Health Care ◽

Random Forest ◽

Health Center ◽

Travel Time ◽

Health Centers ◽

Sub Saharan Africa ◽

Walking Distance ◽

Laboratory System ◽

Government Health ◽

Sub Saharan

Abstract Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity.

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A Multi-Phase Assessment of the Effects of COVID-19 on Food Systems and Rural Livelihoods in Zimbabwe

10.19088/apra.2021.034 ◽

2021 ◽

Author(s):

Vine Mutyasira

Keyword(s):

Food Systems ◽

Smallholder Farmers ◽

Rapid Assessment ◽

Policy Research ◽

Rural Livelihoods ◽

Mitigation Strategies ◽

Sub Saharan Africa ◽

Response Measures ◽

Sub Saharan ◽

Multi Phase

The COVID-19 pandemic has continued to affect agri-food systems around the world and lay bare its fragility, worsening the welfare of millions of smallholder farmers whose livelihoods are anchored on agricultural activities. For the vast majority of sub-Saharan Africa, COVID-19 has coincided with a number of other macroeconomic shocks, which have also exacerbated the impacts of the pandemic on food security, nutrition and general livelihoods, as well curtailed policy responses and mitigation strategies. In Zimbabwe, the COVID-19 pandemic struck at a time the country was experiencing a worsening economic and humanitarian situation. This study focused more on community and household dynamics and response measures to cope with the pandemic. This paper presents a summary of findings emerging from a series of rapid assessment studies undertaken by the Agricultural Policy Research in Africa (APRA) Programme in Mvurwi and Concession areas of Mazowe District in Zimbabwe to examine how COVID-19 is affecting food systems and rural livelihoods in our research communities.

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High-Prevalence Stunting in Preschool Children (1–5 Years) Attending Selected Health Centers in a Food Rich Area-Bushenyi District Southwestern Uganda

Journal of Nutrition and Metabolism ◽

10.1155/2021/5736864 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Douglas Mugarura ◽

Herbert Izo Ninsiima ◽

Hellen Kinyi ◽

Ejike Daniel Eze ◽

Sam Tumwesigire ◽

...

Keyword(s):

Preschool Children ◽

Prevalence Ratio ◽

Cross Sectional Study ◽

Health Centers ◽

Sub Saharan Africa ◽

Cross Sectional ◽

High Prevalence ◽

Development Goals ◽

Chronic Undernutrition ◽

Sub Saharan

The prevalence of stunting among children in Uganda and Sub-Saharan Africa is still high, and if Uganda is to achieve the food-related Sustainable Development Goals (SDGs), it must urgently invest in improving nutrition and sanitation. In a food rich area like Bushenyi, chronic undernutrition could be due to several other factors than mere scarcity of food. The Objective(s). This study was carried out to determine the prevalence and socioclinical factors responsible for chronic undernutrition (stunting) among preschool children aged 1–5 years in selected Health facilities in Bushenyi district. Methodology. This was a cross-sectional study assessing the prevalence of stunting and its associated factors among children aged 1–5 years attending selected health centers in Bushenyi District. Data was collected using a pretested questionnaire, taking anthropometric measurements (height/length), and stool analysis for eggs of soil-transmitted helminthes. Prevalence of stunting was presented as percentages. Logistic regression with adjusted prevalence ratio was performed to test the association between the sociodemographic and clinical factors and stunting at bivariate levels of analysis. Results. Most of the children were female, with a median age of 2.1 years and resided in semiurban areas of Bushenyi with their parents. Prevalence of stunting was 89.3%. Only 10.7% of the children were infested with soil-transmitted helminthes. Children likely to be stunted were those who drank unboiled water and were exclusively breastfed. Conclusion. There is a high prevalence of chronic malnutrition in Bushenyi district associated with parents’/care takers’ low level of knowledge.

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Assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

10.21203/rs.2.19625/v1 ◽

2019 ◽

Author(s):

Amelia Mazzei ◽

Rosine Ingabire ◽

Etienne Karita ◽

Jeannine Mukamuyango ◽

Julien Nyombayire ◽

...

Keyword(s):

Family Planning ◽

Health Center ◽

Rural Health ◽

Health Centers ◽

Power Supplies ◽

Government Health ◽

Family Planning Counseling ◽

Rural Health Centers ◽

Long Acting ◽

Gynecological Exam

Abstract Background. There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: 1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; 2) health center capacity building for provision of LARC methods, and 3) LARC promotion by community health workers (CHW) trained in community-based provision (CBP) of oral and injectable contraception. From 2015-2016, this service was integrated into eight government health centers in Kigali, reaching 6,072 clients and resulting in 5,743 LARC insertions. Methods. From May-July 2016, we conducted health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision.Results. Few nurses had received training in LARC insertion (41% implant, 27% intrauterine device (IUD)). All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (average 16.4), implants (average 56.1), functional gynecological exam tables (average 2.3), and lamps for viewing the cervix (average <1). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions. To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.

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