Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data

Abstract Background The Service Availability and Readiness Assessment surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was employed to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres. Results Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.5% vs. 0.7%, p < 0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30 and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval: 0.19–0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates. Conclusion Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be placed on improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

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Constructing a malaria-related health service readiness index and assessing its association with malaria mortality in under 5-year-old children in Burkina Faso

10.21203/rs.3.rs-15656/v3 ◽

2020 ◽

Author(s):

Ourohiré Millogo ◽

Jean Edouard Odilon Doamba ◽

Ali Sié ◽

Juerg Utzinger ◽

penelope vounatsou

Keyword(s):

Mortality Rate ◽

Health System ◽

Burkina Faso ◽

Health Facility ◽

Mortality Rates ◽

Essential Medicines ◽

Health Management Information System ◽

Malaria Mortality ◽

Health Centres ◽

Facility Readiness

Abstract Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.Methods: Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres.Results: Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.46% vs. 0.72%, p<0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30% and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates.Conclusion: Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be given to improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

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Association between malaria-related health service readiness and malaria mortality in under 5-year-old children in Burkina Faso

10.21203/rs.3.rs-15656/v2 ◽

2020 ◽

Author(s):

Ourohiré Millogo ◽

Jean Edouard Odilon Doamba ◽

Ali Sié ◽

Juerg Utzinger ◽

Penelope Vounatsou

Keyword(s):

Mortality Rate ◽

Health System ◽

Burkina Faso ◽

Health Facility ◽

Health Centers ◽

Essential Medicines ◽

Malaria Mortality ◽

Medical Centers ◽

Health Centres ◽

Facility Readiness

Abstract Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods: Data on malaria-related visits and deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centers and 546 peripheral health centers. Results: Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.46 vs 0.72%, p<0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of essential medicines tracer indicators). Basic equipment readiness was the highest. The composite readiness score explained 30% and 53% of the original indicators for medical centers and peripheral health centers, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of peripheral health centers, compared to the low readiness group. Medical centers readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate showed that regions with high mortality rate have also high proportion of health facilities with low readiness and vice versa. Conclusion: Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be given to improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

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Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data

10.21203/rs.3.rs-15656/v4 ◽

2020 ◽

Author(s):

Ourohiré Millogo ◽

Jean Edouard Odilon Doamba ◽

Ali Sié ◽

Juerg Utzinger ◽

penelope vounatsou

Keyword(s):

Mortality Rate ◽

Burkina Faso ◽

Mortality Rates ◽

Essential Medicines ◽

Service Availability ◽

Readiness Assessment ◽

Malaria Mortality ◽

Health Centres ◽

Geostatistical Models ◽

Facility Readiness

Abstract Abstract Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods: Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres. Results: Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.46% vs. 0.72%, p<0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30% and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates. Conclusion: Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be given to improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system. Keywords: Bayesian geostatistical models, Burkina Faso, Composite readiness index, Malaria, Service Availability and Readiness Assessment

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Association between malaria-related health service readiness and malaria mortality in under 5-year-old children in Burkina Faso

10.21203/rs.3.rs-15656/v1 ◽

2020 ◽

Author(s):

Ourohiré Millogo ◽

Jean Edouard Odilon Doamba ◽

Ali Sié ◽

Juerg Utzinger ◽

Penelope Vounatsou

Keyword(s):

Burkina Faso ◽

Health Facility ◽

Health Management ◽

Multiple Correspondence Analysis ◽

Credible Interval ◽

Mortality Data ◽

Health Management Information System ◽

Malaria Mortality ◽

Geostatistical Models ◽

Facility Readiness

Abstract Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.Methods: Data on malaria-related visits and associated deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA), applied to the selected indicators, was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models were employed to characterise the geographical distribution of facility malaria readiness. The analysis was carried out separately for 112 medical centres (“health facility order 1”; HF1) and 546 dispensaries (HF2).Results: The composite readiness score explained 30% and 53% of the original indicators for HF1 and HF2, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of HF2, compared to the low readiness group. HF1 readiness was not related to malaria mortality.Conclusion: Performant health services in resource-constrained settings are associated with lower malaria mortality rates. To accelerate progress towards malaria elimination in low-resource settings, appropriate funding should be made available to strengthen health systems.

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Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique

BMC Health Services Research ◽

10.1186/s12913-019-4820-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Neusa BAY ◽

Edna JUGA ◽

Carlos MACUACUA ◽

José JOÃO ◽

Maria COSTA ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Health System ◽

Health Facility ◽

Essential Medicines ◽

World Health ◽

Diagnostic Tools ◽

Clinical Protocols ◽

Double Burden ◽

Related Factors

Abstract Background Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

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Epidemiological analysis of deaths and hospitalizations due to Alzheimer’s in Brazil from 2015 to 2019

10.5327/1516-3180.346 ◽

2021 ◽

Author(s):

Gabriella Ribeiro de Almeida ◽

Ana Júlia Omodei Rodrigues Martim ◽

Ana Maria Bezerra Ramos ◽

Anniele Eline Lima Menezes ◽

Giovanna de Amorim Papaléo ◽

...

Keyword(s):

Mortality Rate ◽

Observational Study ◽

Health System ◽

Cause Of Death ◽

Mortality Rates ◽

Progressive Increase ◽

Retrospective Observational Study ◽

Descriptive Data ◽

Epidemiological Analysis ◽

Unified Health System

Background: In 2050, Alzheimer’s disease (AD) may affect 14 million people worldwide, being considered the fourth leading cause of death in adults. Objectives: Analyze the variation in deaths, mortality rate and hospitalizations for AD from 2015 to 2019, in Brazil. Methods: We conducted a retrospective observational study of descriptive data from the Department of the Unified Health System (DATASUS). Results: In Brazil, from 2015 to 2019, there were 9045 hospitalizations and 1786 deaths from AD. Registering an increase in the total of dead about 75% (2015: n = 221; 2019: n = 386). In the years 2015-2019, the following mortality rates were recorded: 13.69; 14.86; 19.26; 21.23; 24,13, showing a smaller difference between the years 2015 and 2016 with 8.6%, and a greater difference between the deaths of 2016 and 2017 with 29%. Despite the growing trend of deaths from AD, there was a variation in the number of cases of hospitalizations in the analyzed period, with the following numbers per year, from 2015- 2019, respectively: 1,614; 1,501; 1,568; 1,550; 1,600, thus explaining that the year with the highest number of hospitalizations was 2015 (n = 1614), while the lowest was 2016 (n = 1501), showing a decrease between 2015-2019 of 0.86%. Conclusion: It was noted that 2019 had 165 more deaths than the year 2015 and a progressive increase in the mortality rate between 2015-2019. However, the number of hospitalizations during the study period was variable.

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Assessment of Care Provision for Hypertension at Emergency Department of an Urban Hospital in Mozambique

10.21203/rs.2.15910/v1 ◽

2019 ◽

Author(s):

Neusa Vanessa Amad Bay ◽

Edna JUGA ◽

Carlos MACUACUA ◽

Jose JOAO ◽

Maria ANIBAL ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Health System ◽

Health Facility ◽

Essential Medicines ◽

World Health ◽

Diagnostic Tools ◽

Clinical Protocols ◽

Double Burden ◽

Related Factors

Abstract Background: Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods: During a pragmatic and prospective 30-day snapshot study (with 24 hour surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral De Mavalane, Maputo, we assessed patient’s flow, infrastructure and resources through direct observation, and reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results: Hypertensive patients had several stops during their journey inside the health facility, and followed a non-standardized flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions: Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

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Impact evaluation of the free maternal healthcare policy on the risk of neonatal and infant deaths in four sub-Saharan African countries: a quasi-experimental design with propensity score Kernel matching and difference in differences analysis

BMJ Open ◽

10.1136/bmjopen-2019-033356 ◽

2020 ◽

Vol 10 (5) ◽

pp. e033356

Author(s):

Duah Dwomoh ◽

Kofi Agyabeng ◽

Kwame Agbeshie ◽

Gabriel Incoom ◽

Priscilla Nortey ◽

...

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Burkina Faso ◽

Health Surveys ◽

Mortality Rates ◽

Maternal Healthcare ◽

Difference In Differences ◽

Quasi Experimental ◽

Sub Saharan ◽

The Impact

ObjectiveDespite the huge financial investment in the free maternal healthcare policy (FMHCP) by the Governments of Ghana and Burkina Faso, no study has quantified the impact of FMHCP on the relative reduction in neonatal and infant mortality rates using a more rigorous matching procedure with the difference in differences (DID) analysis. This study used several rounds of publicly available population-based complex survey data to determine the impact of FMHCP on neonatal and infant mortality rates in these two countries.DesignA quasi-experimental study to evaluate the FMHCP implemented in Burkina Faso and Ghana between 2007 and 2014.SettingDemographic and health surveys and maternal health surveys conducted between 2000 and 2014 in Ghana, Burkina Faso, Nigeria and Zambia.ParticipantsChildren born 5 years preceding the survey in Ghana, Burkina Faso, Nigeria and Zambia.Primary outcome measuresNeonatal and infant mortality rates.ResultsThe Propensity Score Kernel Matching coupled with DID analysis with modified Poisson showed that the FMHCP was associated with a 45% reduction in the risk of neonatal mortality rate in Ghana and Burkina Faso compared with Nigeria and Zambia (adjusted relative risk (aRR)=0.55, 95% CI: 0.40 to 0.76, p<0.001). In addition, infant mortality rate has reduced significantly in both Ghana and Burkina Faso by approximately 54% after full implementation of FMHCP compared with Nigeria and Zambia (aRR=0.46, 95% CI: 0.36 to 0.59, p<0.001).ConclusionThe FMHCP had a significant impact and still remains relevant in achieving Sustainable Development Goal 3 and could provide lessons for other sub-Saharan countries in the design and implementation of a similar policy.

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Initial Report of Off-Pump Coronary Artery Bypass Surgery as Sole Therapy for Moderate Ischemic Mitral Regurgitation: Operative and Intermediate-Term Outcome

The Heart Surgery Forum ◽

10.1532/hsf98.20041162 ◽

2005 ◽

Vol 8 (2) ◽

pp. 89 ◽

Cited By ~ 3

Author(s):

Kevin M. Harris ◽

Avinash Reddy ◽

Dorothee Aepplii ◽

Betsy Wilson ◽

Robert W. Emery

Keyword(s):

Coronary Artery ◽

Mortality Rate ◽

Mitral Regurgitation ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Mortality Rates ◽

Off Pump ◽

Moderate Ischemic Mitral Regurgitation ◽

Pump Coronary Artery Bypass

Background: Patients undergoing on-pump coronary artery bypass surgery (CAB) with coexistent moderate ischemic mitral regurgitation (IMR) have a significant mortality rate compared to patients without MR. The mortality rate is elevated both perioperatively (0%-12% mortality), as well as over a 1- and 2-year postoperative period (15%-25%). It is thought that some patients are best served by off-pump CAB (OPCAB); however, outcomes have not been reported for such patients with coexistent moderate IMR. Methods: We reviewed the independent database of patients undergoing OPCAB between 1995 and 2002 to find 989 patients, 17 (1.7%) of whom had moderate or moderately severe MR. Patients were contacted and clinical and echocardiographic data were obtained. Results: The patient group consisted of 11 men and 6 women (age, 65 15 years). The study group had a PA pressure of 52 14, creatinine of 1.6 0.7, and left ventricular ejection fraction of 43 18. Nine patients (53%) had advanced New York Heart Association (class III-IV) heart failure. Mortality rates perioperatively and at 1, 2, and 3 years were 0%, 6.25% (1/16), 12.5% (2/16), and 38% (4/8), respectively. At the time of this report, no patient had returned for a reparative procedure. Conclusion: In patients felt to be best served by OPCAB with ischemic MR, operative and intermediate mortality rates are remarkably similar to those previously reported for on-pump series. These data underscore the continued need to understand which patients undergoing CAB require mitral valve problems to be addressed at the time of surgery.

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Impact of National Health Mission of India on Infant and Maternal Mortality: A Logical Framework Analysis

Journal of Health Management ◽

10.1177/0972063421994988 ◽

2021 ◽

pp. 097206342199498

Author(s):

Rajesh Kumar

Keyword(s):

Maternal Mortality ◽

Health System ◽

National Health ◽

Maternal Mortality Ratio ◽

Evaluation Framework ◽

Infant Mortality Rate ◽

Series Data ◽

Health Management Information System ◽

Live Births ◽

Fund Allocation

Background: Since independence, life expectancy has increased substantially in India, but the goal of health-for-all has not been achieved yet. Hence, National Rural Health Mission was launched in 2005, and several strategies were implemented to strengthen the health system. Impact evaluation of the mission was done to learn lessons for future health planning. Materials and Methods: Logical evaluation framework was used to examine input, output and impact indicators systematically using time series data from Health Management Information System, National Family Health Surveys, National Sample Surveys and Sample Registration Scheme. Findings: After launch of the mission, fund allocation has increased nearly five times. The number of auxiliary nurse midwives has doubled, and the number of nurses has trebled. The number of accredited social health activists has increased to about one million. Institutional deliveries have increased from 38.7% in 2005–2006 to 78.9% in 2015–2016. Full immunisation coverage has increased from 43.5% to 62%. Oral rehydration solution (ORS) use in childhood diarrhoea has increased from 26% to 51%. Infant mortality rate has declined from 58 in 2005 to 33 per 1,000 live births in 2017 and maternal mortality ratio has also registered a decline from 254 in 2004–2006 to 122/100000 live births in 2015–2017. However, out-of-pocket health expenditure continues to be fairly high (69.3% of the total expenditure on health). Conclusions: Though National Health Mission has made a significant impact, the goal of universal care coverage is not yet fully achieved. Hence, capacity of health system needs to be trebled by a substantial increase in fund allocation.

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