Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi

Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as ‘acute respiratory infection’ using InterVA-4. Data were extracted from free-text narratives based on domains in the ‘Pathways to Survival’ framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.

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Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)

BMC Public Health ◽

10.1186/s12889-021-10232-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gebretsadik Shibre ◽

Betregiorgis Zegeye ◽

Dina Idriss-Wheeler ◽

Sanni Yaya

Keyword(s):

Health Surveys ◽

Demographic And Health Surveys ◽

Care Seeking ◽

Health Seeking ◽

Under Five ◽

Under Five Children ◽

Care Seeking Behavior ◽

Seeking Behavior ◽

Index Of Inequality ◽

Suspected Pneumonia

Abstract Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

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Epidemiological features and medical care-seeking process of patients with COVID-19 in Wuhan, China

ERJ Open Research ◽

10.1183/23120541.00142-2020 ◽

2020 ◽

Vol 6 (2) ◽

pp. 00142-2020 ◽

Cited By ~ 3

Author(s):

Jing Hua ◽

Rongzhang Chen ◽

Liming Zhao ◽

Xiaodong Wu ◽

Qian Guo ◽

...

Keyword(s):

Medical Care ◽

Early Recognition ◽

Early Stage ◽

Evaluation Process ◽

Clinical Information ◽

Healthcare Setting ◽

Care Seeking ◽

Medical Visit ◽

Illness Onset ◽

Clinical Recovery

BackgroundWe aimed to investigate the epidemiological and clinical features, and medical care-seeking process of patients with the 2019 coronavirus disease (COVID-19) in Wuhan, China, to provide useful information to contain COVID-19 in other places with similar outbreaks of the virus.MethodsWe collected epidemiological and clinical information of patients with COVID-19 admitted to a makeshift Fangcang hospital between 7 and 26 February, 2020. The waiting time of each step during the medical care-seeking process was also analysed.ResultsOf the 205 patients with COVID-19 infection, 31% had presumed transmission from a family member. 10% of patients had hospital-related transmission. It took as long as a median of 6 days from the first medical visit to receive the COVID-19 nucleic acid test and 10 days from the first medical visit to hospital admission, indicating early recognition of COVID-19 was not achieved at the early stage of the outbreak, although these delays were shortened later. After clinical recovery from COVID-19, which took a mean of 21 days from illness onset, there was still a substantial proportion of patients who had persistent SARS-CoV-2 infection.ConclusionsThe diagnostic evaluation process of suspected patients needs to be accelerated at the epicentre of the outbreak and early isolation of infected patients in a healthcare setting rather than at home is urgently required to stop the spread of the virus. Clinical recovery is not an appropriate criterion to release isolated patients and as long as 4 weeks' isolation for patients with COVID-19 is not enough to prevent the spread of the virus.

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Underreporting of communicable diseases in the prefecture of Achaia, western Greece, 1999-2004 – missed opportunities for early intervention

Eurosurveillance ◽

10.2807/ese.15.21.19579-en ◽

2010 ◽

Vol 15 (21) ◽

Cited By ~ 16

Author(s):

E Jelastopulu ◽

G Merekoulias ◽

E C Alexopoulos

Keyword(s):

Infectious Diseases ◽

Control Strategies ◽

Health Centre ◽

Health Resources ◽

Health Department ◽

Public Health Department ◽

Missed Opportunities ◽

Notification System ◽

And Control ◽

Western Greece

This study investigates the completeness of the reporting of infectious diseases in the prefecture of Achaia, western Greece in the period of 1999-2004. We collected hospital records relating to infectious diseases retrospectively from three major hospitals in the region and compared the records to corresponding records at the prefectural public health department (PHD). After record-linkage and cross-validation a total of 1,143 notifiable cases were identified in the three hospitals, of which 707 were reported to the PHD of Achaia, resulting in an observed underreporting of infectious diseases of 38% during the study period. At prefecture level, a further 259 cases were notified by other sources, mainly by the fourth hospital of the region not included in our study, resulting in a total of 966 cases reported to the PHD; 73% of these were reported from the three hospitals included in our study, 27% were notified by the fourth hospital not included in our study and less then 0,3% by physicians working in a private practice or health centre. Meningitis (51%), tuberculosis (12%) and salmonellosis (8%) were the most frequently reported diseases followed by hospitalised cases of varicella (7%), brucellosis (6%) and hepatitis (6%). During the study period, clustering of specific diseases like brucellosis, meningitis, mumps, and salmonellosis was observed, indicating possible outbreaks. Our results show that notification system needs to be improved, in order to ensure proper health resources allocation and implementation of focused prevention and control strategies.

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Data Quality of the Routine Health Management Information System at the Primary Healthcare Facility and District Levels in Tanzania

10.21203/rs.3.rs-38381/v1 ◽

2020 ◽

Author(s):

SUSAN F. RUMISHA ◽

EMANUEL P. LYIMO ◽

IRENE R. MREMI ◽

PATRICK K. TUNGU ◽

VICTOR S. MWINGIRA ◽

...

Keyword(s):

Information System ◽

Data Quality ◽

Management Information System ◽

Health Management ◽

Health Centre ◽

Healthcare Facility ◽

Health Management Information System ◽

Management Information ◽

Service Areas

Abstract Background: Effective planning for disease prevention and control requiresaccurate, adequately-analysed, interpreted and communicated data. This study assessed the quality of routine Health Management Information System (HMIS) data at healthcare facility (HF) and district levels in Tanzania. Methods: HMIS tools used at primary health care facilities (dispensary, health centre, hospital) and district office were reviewed to assess their availability, completeness, and accuracy of collected data. The assessment involved seven health service areas namely, Outpatient department, Inpatient department, Antenatal care, Family Planning, Post-natal care, Labour and Delivery and Provider-initiated Testing and Counselling.Results: A total of 115 HFs in 11 districts were assessed. Registers (availability rate=91.1%; interquartile range (IQR):66.7%-100%) and reportforms (86.9%;IQR:62.2%-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%;IQR:35.6%-100%). Tools availability at dispensary was 91.1%, health-centre 82.2% and hospital 77.8%, and was poor in urban districts. The availability rate atthe district level was 65% (IQR:48%-75%). Reports were highly over-represented in comparison to registers’ records, with large differences observed at HF phase of the data journey and more profound in hospitals.Tool availability and data quality varied by service-areas, indicators, facility level, and districts, however, with a remarkable improvement over the years.Conclusion: There are high variations and improvements in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the HFs. These results highlight the need to design tailored and inter-service strategies for improving data quality.

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Teamwork

Oxford Handbook of Adult Nursing ◽

10.1093/med/9780198743477.003.0028 ◽

2018 ◽

pp. 587-594

Author(s):

Maria Flynn ◽

Dave Mercer

Keyword(s):

Health Professionals ◽

Healthcare Setting ◽

Healthcare Services ◽

Health Condition ◽

Illness Episode ◽

Wide Range ◽

Working Together ◽

Effective Organization

The importance of teamworking has been long established in healthcare, with nurses working both as part of a nursing team and as members of the wider multidisciplinary team. The effective organization and delivery of healthcare services depends upon a wide range of health professionals, patients, families, and carers working together to achieve the best health outcomes and quality of life. Whether healthcare is necessary for an acute illness episode, helping someone with a long-term health condition achieve an acceptable level of function, or supporting a person who is dying, placing people at the centre of care decisions demands effective teamworking. Understanding the nature and characteristics of teams can help nurses to work effectively and uphold professional caring values when working with people in any healthcare setting. This chapter outlines the key definitions and characteristics of teamworking.

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Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

BMC Health Services Research ◽

10.1186/s12913-019-4879-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Elizeus Rutebemberwa ◽

Charles Ssemugabo ◽

Raymond Tweheyo ◽

John Turyagaruka ◽

George William Pariyo

Keyword(s):

Health Care Providers ◽

Health Centre ◽

Multivariable Analysis ◽

Sub Saharan Africa ◽

Care Seeking ◽

Care Providers ◽

Adequate Treatment ◽

First Choice ◽

Patients With Epilepsy ◽

First Contact

Abstract Background Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received. Methods A cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed. Results A total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009). Conclusion Patients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.

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HOUSEHOLDS’ HEALTH EXPENDITURES ON ACUTE GASTROENTERITIS IN MALAYSIA

Malaysian Journal of Public Health Medicine ◽

10.37268/mjphm/vol.21/no.2/art.1008 ◽

2021 ◽

Vol 21 (2) ◽

pp. 285-293

Author(s):

Nur Nabila Jusoh ◽

Surianti Sukeri ◽

Hui Yee Chee ◽

Malina Osman ◽

Norashiqin Misni ◽

...

Keyword(s):

Economic Burden ◽

Acute Gastroenteritis ◽

Household Income ◽

Linear Regression Analysis ◽

Productivity Loss ◽

Health Expenditures ◽

Healthcare Facility ◽

Multiple Linear Regression Analysis ◽

Care Seeking ◽

Cross Sectional

Acute gastroenteritis (AGE) causes significant health and economic burden on society. The aim of this study is to estimate households’ direct and indirect expenditures on AGE and its predicted factors. This cross-sectional study was conducted between December 2019 and March 2020 using a bilingual proforma distributed using Survey Monkey among individuals with self-reported AGE in all 14 states of Malaysia. The finding revealed the average expenditure for a single episode of AGE was RM395.58 (± SD 798.02). The mean indirect expenditure was higher at RM259.14 (± SD 379.92) vs. direct expenditure of RM136.44 (± SD 596.47). The highest expenditure was seen among those who obtained inpatient care. The multiple linear regression analysis showed that household income (RM0.13; 95% CI: 0.01, 0.27; p=0.043) and type of healthcare facility (private vs government) (RM1842.05; 95% CI: 395.13, 3288.98; p=0.014) had a significant association with households’ total health expenditure on AGE. Acute gastroenteritis incurred substantial costs on all affected households regardless of care-seeking modalities. Interestingly, the main economic burden of AGE was the indirect cost of productivity loss; interpreted in terms of days away from work. In conclusion, AGE instigated an economic burden on both households and employers. The household income and type of facility were found to be significant factors associated with the households’ health expenditures due to AGE. This study recommends food safety awareness among the public and enforcement of safe food handling practices among food vendors and industries.

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Risk Factors for Workplace Encounters with Weapons by Hospital Employees

10.21203/rs.3.rs-77376/v1 ◽

2020 ◽

Author(s):

James Blando ◽

Chalsie Paul ◽

Mariana Szklo-Coxe

Keyword(s):

Workplace Violence ◽

Standard Procedure ◽

Organizational Factors ◽

Healthcare Setting ◽

Healthcare Facility ◽

Cross Sectional Survey ◽

Related Factors ◽

Cross Sectional ◽

Psychiatric Units ◽

Metal Detectors

Abstract Background:Healthcare workers are at a high risk of experiencing workplace violence and associated injuries, and the presence of weapons in a healthcare setting increases the potential severity of injuries and consequences of violence. The specific aim of this study was to determine which organizational factors were associated with frequent weapons confiscation in a healthcare facility and to identify potential effective interventions. This study investigated the hypothesis that hospital-related factors impact the frequency of weapons confiscation.Methods:A cross-sectional survey was administered on-line to hospital security directors and assessed the associations of organizational factors with the frequency of weapons confiscation.Results: It was found that hospitals with metal detectors were more than 5 times as likely to frequently confiscate weapons, suggesting this intervention is effective. It was also found that hospitals with psychiatric units were more likely to have frequent confiscation of weapons, likely due to the standard procedure of searching patients before admission to the psychiatric unit. Several factors thought to be potentially related, such as perception of risk and state violent crime rates, were not associated with weapons confiscation risk. Conclusion: This data suggests that searching patients and using metal detectors are important tools in the prevention of weapons entering a healthcare setting. This reduction would likely enhance safety and reduce injury from workplace violence.

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Missed opportunities for HIV pre-exposure prophylaxis during a rapid scale-up program at Sydney Sexual Health Centre

Sexual Health ◽

10.1071/sh19032 ◽

2019 ◽

Vol 16 (6) ◽

pp. 591

Author(s):

David Atefi ◽

Ruthy McIver ◽

Christopher Bourne

Keyword(s):

Sexual Health ◽

Medical Records ◽

Health Centre ◽

Scale Up ◽

Missed Opportunities ◽

Standard Component ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis ◽

Missed Opportunity

We aimed to estimate HIV pre-exposure prophylaxis (PrEP) uptake and missed opportunities for PrEP through a retrospective review of medical records of clients at high risk of HIV attending the Sydney Sexual Health Centre. Most clients (69%) were taking PrEP, and 7% of those eligible for PrEP were classified as a missed opportunity for PrEP. Although missed opportunities were uncommon, PrEP discussions should be a standard component of care for all clients at risk of HIV acquisition.

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