THE IMPORTANCE OF PUBLIC SECTOR HEALTH FACILITY-LEVEL DATA FOR MONITORING CHANGES IN MATERNAL MORTALITY RISKS AMONG COMMUNITIES: THE CASE OF PAKISTAN

SummaryThis paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

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Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

BMJ Global Health ◽

10.1136/bmjgh-2021-005833 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005833

Author(s):

Leena N Patel ◽

Samantha Kozikott ◽

Rodrigue Ilboudo ◽

Moreen Kamateeka ◽

Mohammed Lamorde ◽

...

Keyword(s):

Health Facility ◽

Healthcare Workers ◽

National Level ◽

Lessons Learned ◽

Health Facilities ◽

Infection Prevention And Control ◽

Health Facility Level ◽

Ensure Patient Safety ◽

Increased Risk ◽

Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

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Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda

PLoS ONE ◽

10.1371/journal.pone.0241611 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241611

Author(s):

Stella Zawedde-Muyanja ◽

Joseph Musaazi ◽

Yukari C. Manabe ◽

Achilles Katamba ◽

Joaniter I. Nankabirwa ◽

...

Keyword(s):

Public Health ◽

Health Facility ◽

Health Facilities ◽

Vital Status ◽

Loss To Follow Up ◽

Public Health Facilities ◽

Tb Treatment ◽

Health Facility Level ◽

Facility Level

Introduction Tuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda. Methods At ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU. Results Of 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%). Conclusion Patients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.

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Health Characteristics and Utilization of Public Sector Health Facilities Among Migrant Agricultural Workers in Orange County, New York

Journal of Health & Social Policy ◽

10.1300/j045v04n01_06 ◽

1992 ◽

Vol 4 (1) ◽

pp. 57-75 ◽

Cited By ~ 8

Author(s):

Shelley I White-Means

Keyword(s):

New York ◽

Public Sector ◽

Orange County ◽

Health Facilities ◽

Agricultural Workers ◽

Public Sector Health ◽

Characteristics And Utilization

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A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region

Expert Review of Vaccines ◽

10.1080/14760584.2020.1791088 ◽

2020 ◽

Vol 19 (7) ◽

pp. 639-651

Author(s):

Chinwe Juliana Iwu ◽

Ntombehle Ngcobo ◽

Anelisa Jaca ◽

Alison Wiyeh ◽

Elizabeth Pienaar ◽

...

Keyword(s):

Systematic Review ◽

Health Facility ◽

African Region ◽

Health Facility Level ◽

Facility Level ◽

Vaccine Availability

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Baseline results of the first malaria indicator survey in Iran at the health facility level

Malaria Journal ◽

10.1186/1475-2875-10-319 ◽

2011 ◽

Vol 10 (1) ◽

pp. 319 ◽

Cited By ~ 5

Author(s):

Ahmad Raiesi ◽

Fatemeh Nikpour ◽

Alireza Ansari-Moghaddam ◽

Mansoor Ranjbar ◽

Fatemeh Rakhshani ◽

...

Keyword(s):

Health Facility ◽

Malaria Indicator Survey ◽

Health Facility Level ◽

Facility Level

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Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010: A retrospective study

Curationis ◽

10.4102/curationis.v37i1.1169 ◽

2014 ◽

Vol 37 (1) ◽

Cited By ~ 1

Author(s):

Mohammed M. Gafar ◽

Norman Z. Nyazema ◽

Yoswa M. Dambisya

Keyword(s):

South Africa ◽

Treatment Outcomes ◽

Health Facility ◽

Treatment Regimen ◽

Diagnostic Category ◽

Limpopo Province ◽

World Health ◽

Factors Influencing ◽

Health Facility Level ◽

Facility Level

Background: South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrugresistant TB.Objectives: To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province.Method: A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes.Results: Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22–55, and 56–74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II.Conclusion: The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services.

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Capacity of Ugandan public sector health facilities to prevent and control non-communicable diseases: an assessment based upon WHO-PEN standards

BMC Health Services Research ◽

10.1186/s12913-018-3426-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 12

Author(s):

Hilary E. Rogers ◽

Ann R. Akiteng ◽

Gerald Mutungi ◽

Adrienne S. Ettinger ◽

Jeremy I. Schwartz

Keyword(s):

Public Sector ◽

Communicable Diseases ◽

Health Facilities ◽

Non Communicable Diseases ◽

Public Sector Health ◽

And Control

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Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria

Health Policy and Planning ◽

10.1093/heapol/czy032 ◽

2018 ◽

Vol 33 (5) ◽

pp. 666-674 ◽

Cited By ~ 2

Author(s):

Atsumi Hirose ◽

Ibrahim O Yisa ◽

Amina Aminu ◽

Nathanael Afolabi ◽

Makinde Olasunmbo ◽

...

Keyword(s):

Public Sector ◽

Health Facilities ◽

Delivery Care ◽

Technical Quality ◽

Quality Of Delivery ◽

Private And Public ◽

Public Sector Health

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Mapping maternal and newborn healthcare access in West African Countries

10.21203/rs.2.11583/v2 ◽

2019 ◽

Author(s):

Dorothy Ononokpono ◽

Bernard Baffour ◽

Alice Richardson

Keyword(s):

Health Outcomes ◽

Health Facility ◽

Healthcare Access ◽

Newborn Health ◽

West African ◽

Health Facilities ◽

Maternal And Newborn Health ◽

African Countries ◽

Live Births ◽

Maternal And Newborn

Abstract Background: The Sustainable Development Goal (SDG) three emphasizes the need to improve maternal and newborn health, and reduce global maternal mortality ratio to less than 70 per 100 000 live births by 2030. Achieving the SDG goal 3.1 target will require evidence based data on concealed inequities in the distribution of maternal and child health outcomes and their linkage to healthcare access. The objectives of this study were to estimate the number of women of reproductive age, pregnancies and live births at subnational level using high resolution maps and to quantify the number of pregnancies within user-defined distances or travel times of a health facility in three poor resource West African countries: Mali, Guinea and Liberia. Methods: The maternal and newborn health outcomes were estimated and mapped for the purpose of visualization using geospatial analytic tools. Buffer analysis was then performed to assess the proximity of pregnancies to health facilities with the aim of identifying pregnancies with inadequate access (beyond 50km) to a health facility. Results: Results showed wide variations in the distribution of maternal and newborn health outcomes across the countries of interest and districts of each of the countries. There was also clustering of health outcomes and health facilities at the urban capital cities of Bamako, Conakry, and Greater Monrovia. Conclusion: To bridge the gap in inequity in healthcare access, and improve maternal and newborn health in the study countries, there is need for equitable distribution of human resources and infrastructure within and across the various districts.

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