scholarly journals Challenges with Scale-up of GeneXpert MTB/RIF® in Uganda: a Health Systems Perspective

2019 ◽  
Author(s):  
Talemwa Nalugwa ◽  
Priya B. Shete ◽  
Mariam Nantale ◽  
Katherine Farr ◽  
Christopher Ojok ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Systems ◽  
Community Health Centers ◽  
Scale Up ◽  
Health Centers ◽  
Data Sources ◽  
Cross Sectional ◽  
Hub And Spoke ◽  
System Factors

Abstract Background Many high burden countries are scaling-up GeneXpert® MTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify health system factors that may enhance or prevent high-quality implementation of Xpert testing services. Methods We conducted a cross-sectional study triangulating quantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Results Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2,241 patients eligible for TB testing, only 580 (26%) were referred for Xpert testing. Of those, 57 (9.6%) were Xpert confirmed positive just over half initiated treatment within 14 days (n=33, 58%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n=14, X%) for sputum testing and lack of telephone/mobile communication (n=21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once a week, 2x/week or 3x/week at 10 (43%), 9 (39%) and 4 (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only 2 health centers. Of the 15 Xpert testing sites, 5 (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates >5%. Conclusions Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration.

scholarly journals Challenges with Scale-up of GeneXpert MTB/RIF® inUganda: a Health Systems Perspective

2020 ◽  
Author(s):  
Talemwa Nalugwa ◽  
Priya B. Shete ◽  
Mariam Nantale ◽  
Katherine Farr ◽  
Christopher Ojok ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Systems ◽  
Community Health Centers ◽  
Scale Up ◽  
Health Centers ◽  
Data Sources ◽  
Cross Sectional ◽  
Hub And Spoke ◽  
System Factors

Abstract Background: Many high burden countries are scaling-up GeneXpert MTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify health system factors that may enhance or prevent high-quality implementation of Xpert testing services. Methods: We conducted a cross-sectional study triangulating quantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Results: Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2,192 patients eligible for TB testing, only 574 (26%) who initiated testing were referred for Xpert testing. Of those, 54 (9.4%)were Xpert confirmed positive just under half initiated treatment within 14 days (n=25, 46%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n=14, 61%) for sputum testing and lack of telephone/mobile communication (n=21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once, twice, or three times a week at 10 (43%), nine (39%) and four (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only two health centers. Of the 15 Xpert testing sites, five (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates >5%. Conclusions: Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration.

scholarly journals Challenges with Scale-up of GeneXpert MTB/RIF® inUganda: a Health Systems Perspective

2020 ◽  
Author(s):  
Talemwa Nalugwa ◽  
Priya B. Shete ◽  
Mariam Nantale ◽  
Katherine Farr ◽  
Christopher Ojok ◽  
...  
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Community Health Centers ◽  
Scale Up ◽  
Evaluation Process ◽  
Median Number ◽  
Health Centers ◽  
Data Sources ◽  
Cross Sectional ◽  
Hub And Spoke

Abstract Background: Many high burden countries are scaling-up GeneXpertÒMTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify healthsystem factors that may enhance or prevent high-qualityimplementation of Xpert testing services. Methods: We conducted a cross-sectional study triangulatingquantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Results: Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2,192 patients eligible for TB testing, only 574 (26%) who initiated testing were referred for Xpert testing. Of those, 54 (9.4%)were Xpert confirmed positive just under half initiated treatment within 14 days (n=25, 46%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n=14, 61%) for sputum testing and lack of telephone/mobile communication (n=21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once, twice, or three times a week at 10 (43%), nine (39%) and four (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only two health centers. Of the 15 Xpert testing sites, five (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates >5%. Conclusions: Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration.

scholarly journals Challenges with Scale-up of GeneXpert MTB/RIF® inUganda: a Health Systems Perspective

2019 ◽  
Author(s):  
Talemwa Nalugwa ◽  
Priya B. Shete ◽  
Mariam Nantale ◽  
Katherine Farr ◽  
Christopher Ojok ◽  
...  
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Community Health Centers ◽  
Scale Up ◽  
Evaluation Process ◽  
Median Number ◽  
Health Centers ◽  
Data Sources ◽  
Cross Sectional ◽  
Hub And Spoke

Abstract Background: Many high burden countries are scaling-up GeneXpertÒMTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify healthsystem factors that may enhance or prevent high-qualityimplementation of Xpert testing services. Methods: We conducted a cross-sectional study triangulatingquantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. Results: Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2,192 patients eligible for TB testing, only 574 (26%) who initiated testing were referred for Xpert testing. Of those, 54 (9.4%)were Xpert confirmed positive just under half initiated treatment within 14 days (n=25, 46%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n=14, X%) for sputum testing and lack of telephone/mobile communication (n=21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once a week, 2x/week or 3x/week at 10 (43%), 9 (39%) and 4 (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only 2 health centers. Of the 15 Xpert testing sites, 5 (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates >5%. Conclusions: Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration.

scholarly journals KNOWLEDGE, ATTITUDE, AND PRACTICE OF COUGH ETIQUETTE IN PATIENTS WITH TUBERCULOSIS IN THE COMMUNITY HEALTH CENTERS

2018 ◽  
Vol 4 (5) ◽  
pp. 482-491
Author(s):  
Desy Indra Yani ◽  
Yayat Fajar Hidayat ◽  
Afif Amir Amrullah
Keyword(s):  
Community Health ◽  
Community Health Centers ◽  
Acid Fast Bacillus ◽  
Mean Value ◽  
Health Care Facilities ◽  
Health Centers ◽  
Cross Sectional ◽  
Attitude And Practice ◽  
Droplet Nuclei ◽  
Knowledge Attitude And Practice

Background: Tuberculosis is the major global health problem. A high number of tuberculosis cases are as a result of the disease spreads through droplet nuclei which mainly through a cough. Transmission prevention of tuberculosis is important to lower the rate of new infection. Since the transmission is through a cough, therefore, one of the preventive behaviors is by implementing the good and right cough etiquette. Objectives: The aim of this study was to find out the overview of knowledge, attitude and practice of cough etiquette in patients with tuberculosis. Methods: This study was descriptive quantitative with the cross-sectional approach. The population were all patients with Acid-Fast Bacillus (AFB) and tuberculosis registered in Community Health Centers of Rancaekek, Linggar and Nanjung Mekar in Bandung, Indonesia. A total sampling was used with a total number of 52 patients. Data on knowledge, attitude, and practice were measured via validated questionnaires and observation sheets. Frequency distribution, mean and median were used for data analysis. Results: Of the total respondents, 65.4% of the respondents had good knowledge about cough etiquette (median value 83.33 and IQR 20), 50.9% had negative cough etiquette attitude (mean value 47.87 and SD 5.885), and 63.5% had bad practice in cough etiquette (median value 5 and IQR 2). Conclusions: The result of this study is expected to be an input for primary health care facilities in doing improvement in delivering health education to patients with tuberculosis and their families about the good and right cough etiquette, which focus on the affective and psychomotor aspects to prevent the spread of tuberculosis and decrease its infection. This article has been corrected. A separate erratum can be seen at  https://doi.org/10.33546/bnj.1153

scholarly journals Entomological Surveillance of Malaria Vectors in Saumlaki, Maluku Tenggara Barat Regency, Maluku Province

2017 ◽  
Vol 12 (2) ◽  
pp. 262-269
Author(s):  
Semuel Sandy ◽  
Ivon Ayomi ◽  
Melda S Suebu ◽  
Y Maladan ◽  
M Rahardjo Pardi ◽  
...  
Keyword(s):  
Community Health ◽  
Human Blood ◽  
Community Health Centers ◽  
Larval Density ◽  
Health Centers ◽  
Malaria Vectors ◽  
Entomological Surveillance ◽  
Cross Sectional ◽  
Blood Index ◽  
Cross Sectional Design

The research aims to determine the prevalence of malaria and Anopheles spp using bio-ecology surveillance in Alusi and Waturu community health centers in Maluku Tenggara Barat Regency. The study was conducted in March-April 2015 with cross sectional design. In this research, we performed mass blood survey on 489 participants in the Kilmasa village and 434 participants in Waturu village. We also performed entomology surveillances, i.e. larval density, catching Anopheles spp, temperature, humidity, and salinity. To confirm malaria vectors, we used enzyme linked immunoabsorbent assay (ELISA) techniques. The data analyzed descriptively. The results of the study showed proportion 0.20% malaria morbidity in Kilmasa village and 0.23% in Waturu village. Anopheles flavirostris and An. barbirostris group were likely to bite a human outside and inside the house and peaked at 11.00 pm-12.00 pm. The parous rate of An. flavirostris and An. barbirostris was 46% and 26%, respectively. Human blood index of An.flavirostris and An. barbirostris was 33.3% and by 70%, respectively. Anopheles flavirostri and An. barbirostris were malaria vectors with sporozoite rate 0.38% and 12.5%, respectively.

scholarly journals Hubungan Tingkat Pengetahuan Pengawas Menelan Obat Dengan Keberhasilan Pengobatan Pasien Tuberkulosis Paru Di Kabupaten Klaten

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Joko Tri Atmojo
Keyword(s):  
Community Health ◽  
Community Health Centers ◽  
Health Department ◽  
Health Centers ◽  
Tuberculosis Treatment ◽  
Bivariate Analysis ◽  
P Value ◽  
Knowledge Level ◽  
Research Subjects ◽  
Cross Sectional

Abstract: Knowledge Level PMO, Success Tuberculosis Treatment. DOTS strategy in Klaten district had begun since 2000 for all community health centers. The success of DOTS in tuberculosis treatment influenced by some factor. One of the factors is PMO behavior to tuberculosis disease. But in 2013, the cure rate in tuberculosis treatment that community health centers have done has decreased. If not cure, it makes an economic and psychological load. The germ in the lung could be resistant and it could infect other people for the same resistant. To determine the relationship between the knowledge level of PMO and the success of tuberculosis treatment. The research was conducted in Klaten district in September – October 2014. The design of this research was a cross-sectional study. Research subjects are PMO that registered in the TB register Health Department District of Klaten in the first quarterly and second quarterly 2013 that can be evaluated in first quarterly and second quarterly 2014 came from 34 community health centers. Total subjects are 97 persons. Data were obtained through questionnaires and direct interviews. Data analysis was held step by step which includes univariate and bivariate analysis using the Kendall tau test. Knowledge level of PMO was significant statistically to the success of tuberculosis treatment (PR = 13,333;95% CI = 3,583 to 49,612 with p-value = 0,004). Knowledge level of PMO that proved to be a risk factor of success tuberculosis treatment

scholarly journals PENGETAHUAN, SIKAP, DAN PERILAKU TENAGA PENOLONG PERSALINAN DI PUSKESMAS KOTA MANADO TERHADAP PROFILAKSIS VITAMIN K

e-CliniC ◽  
2015 ◽  
Vol 3 (2) ◽  
Author(s):  
Sandy Suoth ◽  
Stevanus Gunawan ◽  
Vivekenanda Pateda
Keyword(s):  
Community Health ◽  
Vitamin K ◽  
Cerebral Hemorrhage ◽  
Community Health Centers ◽  
Health Centers ◽  
Infant Mortality Rate ◽  
Good Knowledge ◽  
Cross Sectional ◽  
Live Births ◽  
Vitamin K Prophylaxis

Abstract: In Indonesia, the infant mortality rate (IMR) is 41.4 per 1.000 live births. It is projected that the rate will be 18 per 1.000 live births in 2025. One of the efforts to decrease the IMR is prevention of the occurrence of cerebral hemorrhage in newborns. This hemorrhage is caused by coagulation disorders due to a deficiency of vitamin K. Vitamin K injection is essential for newborns to prevent this hemorrhage. This was a descriptive study with a cross-sectional design that was conducted by using questionnaires. Respondents were taken from 15 community health centers in Manado. The results showed that of the 102 birth aattendants: 60.8% had good knowledge; 69.6% thought that vitamin K prophylaxis should be administered to all newborn babies; 57.8% agreed that this prophylaxis should be administered after birth; 64.7% thought that vitamin K prophylaxis could prevent cerebral hemorrhage of the newborns; 78.4% agreed that vitamin K was available at the community health centers; 56.9% knew that vitamin K prophylaxis did not cause any harmful side effects; 87.3% gave vitamin K prophylaxis to the newborns; 85.3% administered vitamin K to the newbornss immediately after birth; and 89.2% provided community health centers with vitamin K. Conclusion: In this study, most of the birth attendants had good knowledge, administered vitamin K prophylaxis to the newborns, and provided the health community centers with vitamin K.Keywords: cerebral hemorrhage, vitamin K prophylaxis, birth attendantsAbstrak: Indonesia sebagai negara sedang berkembang mempunyai angka kematian bayi (AKB) 41,4 per 1.000 kelahiran hidup yang diproyeksikan menjadi 18 per 1.000 kelahiran hidup pada tahun 2025. Salah satu upaya menurukan AKB ialah dengan mencegah terjadinya perdarahan otak pada bayi baru lahir. Perdarahan ini diakibatkan gangguan proses koagulasi oleh kekurangan vitamin K. Pemberian injeksi vitamin K sangat penting pada bayi baru lahir untuk mencegah perdarahan otak tersebut. Penelitian bersifat deskriptif dengan desain potong lintang dan menggunakan kuesioner yang dibagikan pada tenaga penolong persalinan di 15 puskesmas Kota Manado. Hasil penelitian memperlihatkan bahwa dari 102 tenaga penolong : 60,8% mempunyai tingkat pengetahuan tergolong baik; 69,6% berpendapat bahwa profilaksis vitamin K harus diberikan pada semua bayi baru lahir; 57,8% setuju profilaksis vitamin K bermanfaat untuk mencegah perdarahan bayi baru lahir; 78,4% setuju ketersediaan vitamin K di Puskesmas/Pondok bersalin; 56,9% berpendapat bahwa tidak ada efek samping berbahaya untuk profilaksis vitamin K; 87,3% tenaga kesehatan memberikan profilaksis vitamin K; 85,3% tenaga kesehatan memberikan vitamin K segera setelah lahir; dan 89,2% tenaga kesehatan menyediakan vitamin K di puskesmas/pondok bersalin. Simpulan: Sebagian besar tenaga penolong persalinan pada 15 puskesmas di kota Manado mempunyai tingkat pengetahuan tergolong baik, memberikan profilaksis vitamin K, dan menyediakan vitamin K di puskesmas atau pondok bersalin.Kata kunci: perdarahan serebral, profilaksis vitamin K, tenaga penolong persalinan

Implications for Poor Public Healthcare System of South Korea Revealed in MERS Outbreak

2021 ◽  
pp. 780-788
Author(s):  
MyungHee Kim
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Community Health ◽  
Healthcare System ◽  
Community Health Centers ◽  
Health Centers ◽  
Public Healthcare ◽  
Public Healthcare System ◽  
The Public

This article aims to prevent the possible recurrence of the Middle East Respiratory Syndrome (MERS) by understanding the status of South Korea's public healthcare system through a literature review. In addition, it presents measures to reinforce the public health system by analyzing the roles and limitations of the health authority, which plays a key role in preventing the spread of this infectious disease, through their response to the recent MERS outbreak in the country. Based on the analysis, the results showed the following implications: (1) Community health centers need to expand and reinforce their functions. It is important to publish response manuals at the national level and regularly educate and train medical service providers on infectious disease control, especially against diseases such as MERS. Accordingly, manpower and facilities must be developed. (2) Public hospitals located in regional hubs must expand to establish a public healthcare system. Public healthcare and emergency healthcare systems should be established by connecting community health centers, regional hub hospitals, and national university hospitals. The improvements in the facility must to be supported to help increase the efficiency of public health system. (3) Awareness among people must increase with respect to the prevention of infectious diseases and managing direct contact with infected patients. Most importantly, education and training on infectious disease prevention must be regularly provided to the public, and social support systems and programs must be organized for the infected people who are in self-isolation.

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