Healthcare provider satisfaction with environmental conditions in rural healthcare facilities of 14 low- and middle-income countries

ObjectiveTo identify the associated factors affecting the decision regarding institutional delivery for pregnant women in 14 low- and middle-income countries (LMICs).DesignA special mixed-method design was used to combine cross-sectional studies for harmonising data from Bangladesh and 13 other countries to obtain extended viewpoints on non-utilisation of institutional healthcare facilities during childbirth.SettingDemographic and Health Survey (DHS) data for 14 LMICs were used for the study.ParticipantsThere are several kinds of datasets in the DHS. Among them ‘IndividualWomen’s Records’ was used as this study is based on all ever-married women.ResultsIn the binary logistic and meta-analysis models for Bangladesh, ORs for birth order were 0.57 and 0.51 and for respondents’ age were 1.50 and 1.07, respectively. In all 14 LMICs, the most significant factors for not using institutional facilities during childbirth were respondents’ age (OR 0.903, 95% CI 0.790 to 1.032) and birth order (OR 0.371, 95% CI 0.327 to 0.421).ConclusionBirth order and respondents’ age were the two most significant factors for non-utilisation of healthcare facilities during childbirth in 14 LMICs.

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Low-Cost Bubble-CPAP Treatment of a Severe Case of Pneumonia in a Low- and Middle-Income Country: A Case Report on the Importance of Optimizing Bubble-CPAP Setup

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa049 ◽

2020 ◽

Author(s):

Søren Vinther Larsen ◽

Anja Poulsen

Keyword(s):

Low Cost ◽

Severe Case ◽

Middle Income ◽

Healthcare Facilities ◽

Middle Income Countries ◽

Efficient Delivery ◽

Bubble Cpap ◽

Two Parameters ◽

Lower Respiratory Disease ◽

Low And Middle Income

Abstract A homemade low-cost bubble continuous positive airway pressure (bCPAP) setup can be created using resources available at most secondary healthcare facilities in low- and middle-income countries (LMICs). This setup has the potential of saving millions of children’s lives worldwide; however, treatment failure due to bCPAP setup insufficiencies and lack of educated staff remains a significant obstacle. Here, we report a first-hand experience on the use of an established low-cost bCPAP setup to be used in LMICs and how optimization of two parameters was critical to effectively treat a severe case of lower respiratory disease in a 6-month-old infant in Tanzania. We report this case to strengthen that reducing the resistance in the tube system and minimizing air leakage at the nasal interface are crucial for efficient delivery of the CPAP therapy.

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Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020817 ◽

2021 ◽

Vol 18 (2) ◽

pp. 817

Author(s):

Darcy M. Anderson ◽

Ryan Cronk ◽

Donald Fejfar ◽

Emily Pak ◽

Michelle Cawley ◽

...

Keyword(s):

Systematic Review ◽

Waste Management ◽

Vector Control ◽

Environmental Health ◽

Personal Protective Equipment ◽

Protective Equipment ◽

Middle Income ◽

Healthcare Facilities ◽

Middle Income Countries ◽

Low And Middle Income

A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.

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Water, sanitation, and hygiene (WASH) in healthcare facilities of 14 low- and middle-income countries: to what extent is WASH implemented and what are the ‘drivers’ of improvement in their service levels?

H2Open Journal ◽

10.2166/h2oj.2021.095 ◽

2021 ◽

Author(s):

Laura Kmentt ◽

Ryan Cronk ◽

James Benjamin Tidwell ◽

Elliott Rogers

Keyword(s):

Prevention And Control ◽

Infection Prevention And Control ◽

Middle Income ◽

Service Levels ◽

Healthcare Facilities ◽

Middle Income Countries ◽

Sanitation And Hygiene ◽

Increased Risk ◽

And Control ◽

Low And Middle Income

Abstract Prevention and control of healthcare-associated infections through the provision of water, sanitation, and hygiene (WASH) in healthcare facilities (HCF) is inadequate in low- and middle-income countries (LMICs), resulting in high patient morbidity and mortality, additional costs, and increased risk of antibiotic resistance. There is little evidence describing factors leading to improved WASH conditions in LMICs. We aim to identify the extent to which WASH is implemented in HCFs in LMICs and understand the ‘drivers’ of improvement in their service levels. WASH service levels in 14 LMICs were descriptively analysed, and potential drivers of service-level differences were explored using univariable and multivariable mixed-model logistic regression analyses. Descriptive analysis showed a lack of adequate water quality, sanitation, hand, and environmental hygiene, and waste disposal. We found that the presence of infection prevention and control protocols (IPCPs), having an IPC/WASH focal person at the facility, and conducting WASH training for staff were associated with higher levels of WASH services. This study demonstrates a lack of basic WASH services in HCF in LMICs. We show that there are potential interventions, such as implementing IPCPs, identifying WASH leaders in HCF, and conducting training that may lead to service improvements.

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Mitigating the impact of COVID-19 on tuberculosis and HIV services: a cross-sectional survey of 669 health professionals in 64 low and middle-income countries

10.1101/2020.10.08.20207969 ◽

2020 ◽

Author(s):

Mishal S. Khan ◽

Sonia Rego ◽

Joaquín Benítez Rajal ◽

Virginia Bond ◽

Razia Kaneez Fatima ◽

...

Keyword(s):

Online Survey ◽

Transport Sector ◽

Food Supplementation ◽

Medical Support ◽

Cross Sectional ◽

Middle Income ◽

Healthcare Facilities ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

AbstractObjectiveThe experiences of frontline healthcare professionals are essential in identifying strategies to mitigate the disruption to healthcare services caused by the COVID-19 pandemic.MethodsWe conducted a cross-sectional study of TB and HIV professionals in low and middle-income countries (LMIC). Between May 12 and August 6 2020, we collected qualitative and quantitative data using an online survey in 11 languages. We used descriptive statistics and thematic analysis to analyse responses.Findings669 respondents from 64 countries completed the survey. Over 40% stated that it was either impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. The most common barriers reported to affect patients were: fear of getting infected with SARS-CoV-2, transport disruptions and movement restrictions. 37% and 28% of responses about TB and HIV stated that healthcare provider access to facilities was also severely impacted. Strategies to address reduced transport needs and costs – including proactive coordination between the health and transport sector and cards that facilitate lower cost or easier travel - were presented in qualitative responses. Access to non-medical support for patients, such as food supplementation or counselling, was severely disrupted according to 36% and 31% of HIV and TB respondents respectively; qualitative data suggested that the need for such services was exacerbated.ConclusionPatients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and non-medical support for patients was particularly impacted. Synthesising recommendations of frontline professionals should be prioritised for informing policymakers and healthcare service delivery organisations.

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