scholarly journals Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia

2021 ◽  
Author(s):  
Ilias Hossain ◽  
Philip Hill ◽  
Christian Bottomley ◽  
Momodou Jasseh ◽  
Kalifa Bojang ◽  
...  
Keyword(s):  
Access To Care ◽  
Health Facility ◽  
Low Income ◽  
Disease Incidence ◽  
Community Survey ◽  
Health Facilities ◽  
Community Based ◽  
Healthcare Seeking ◽  
River Region ◽  
Initial Care

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8–25%.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

scholarly journals Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Ayodeji M. Adebayo ◽  
Michael C. Asuzu
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Access To Health Services ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Community Based ◽  
Cross Sectional ◽  
North West

Background: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities.Aim: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria.Settings: A low-income community in Ibadan North West Local Government Area of Oyo State.Methods:A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents’ sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05.Results: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF.Conclusion: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.

scholarly journals Adolescent and Young People's Utilization of HIV/Sexual and Reproductive Health Services: Comparing Health Facilities and Mobile Community Outreach Centers

2019 ◽  
Vol 3 (2) ◽  
pp. 66-74
Author(s):  
Ikenna J. Nwakamma ◽  
Carol S. Talla ◽  
Stephanie E. Kei ◽  
Genevieve C. Okoro ◽  
Godwin Asuquo ◽  
...  
Keyword(s):  
Young People ◽  
Reproductive Health ◽  
Health Facility ◽  
Service Utilization ◽  
Waiting Time ◽  
Sexual And Reproductive Health ◽  
Community Outreach ◽  
Health Facilities ◽  
Community Based ◽  
Mobile Community

Background/Objectives: Demand creation for uptake of HIV and sexual reproductive health (HIV/SRH) services among adolescents and young people (AYP) in Nigeria is challenging. This study compares the reach, and utilization patterns, and factors that drive the patterns of utilization of HIV/SRH services by AYP in mobile outreach service centers and health care facilities in Nigeria's capital city. Methods: Data were obtained from service exit surveys and HIV/SRH service utilization records in selected health facilities and mobile testing outreaches from January to April 2018. The service providers were provided a checklist to capture key information during their interaction with their AYP clients. Data were captured with Microsoft Excel, imported to and analysed with Statistical Package for Social Sciences, version 16. Results: Community-based mobile outreaches reached a significantly higher proportion of participants, with 88% of them from the community HIV testing points. Among the participants in the SRH service utilization assessment, 20 (15%) and 142 (19%) voluntarily asked for SRH-related information in the health facility and mobile outreach respectively; 53 (40%), and 224 (30%) accepted offer of SRH counselling in the health facility and mobile outreach respectively. There were significant differences in the waiting time for testing and waiting time for result collection at the mobile testing posts and the health facilities. Conclusion and Implications for Translation: AYP friendly mobile community outreach model shows more promise in terms of reach and also seems to encourage voluntary request for HIV/SRH services among AYP. The costs and waiting times favor the mobile outreach model; however, the quality in terms of personnel and environment was an issue of concern. Hospitals are not providing friendly environments that encourage voluntary uptake of HIV/SRH services by AYPs. A model for AYPs should prioritize community based and friendly services with well-trained personnel in order to build the confidence of AYPs for improved SRH seeking behaviors. Key words: • HIV • Sexual and reproductive Health • Adolescents and Young People • Preferences • Mobile outreaches services • Health facility testing • Abuja Nigeria   Copyright © 2019 Nwakamma et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.affect economic and health promotion.

scholarly journals Guiding placement of health facilities using multiple malaria criteria and an interactive tool

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kok Ben Toh ◽  
Justin Millar ◽  
Paul Psychas ◽  
Benjamin Abuaku ◽  
Collins Ahorlu ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Malaria Incidence ◽  
Malaria Prevalence ◽  
Health Facilities ◽  
Additive Models ◽  
Northern Ghana ◽  
Community Based ◽  
Location Allocation ◽  
Hypothetical Scenario

Abstract Background Access to healthcare is important in controlling malaria burden and, as a result, distance or travel time to health facilities is often a significant predictor in modelling malaria prevalence. Adding new health facilities may reduce overall travel time to health facilities and may decrease malaria transmission. To help guide local decision-makers as they scale up community-based accessibility, the influence of the spatial allocation of new health facilities on malaria prevalence is evaluated in Bunkpurugu-Yunyoo district in northern Ghana. A location-allocation analysis is performed to find optimal locations of new health facilities by separately minimizing three district-wide objectives: malaria prevalence, malaria incidence, and average travel time to health facilities. Methods Generalized additive models was used to estimate the relationship between malaria prevalence and travel time to the nearest health facility and other geospatial covariates. The model predictions are then used to calculate the optimisation criteria for the location-allocation analysis. This analysis was performed for two scenarios: adding new health facilities to the existing ones, and a hypothetical scenario in which the community-based healthcare facilities would be allocated anew. An interactive web application was created to facilitate efficient presentation of this analysis and allow users to experiment with their choice of health facility location and optimisation criteria. Results Using malaria prevalence and travel time as optimisation criteria, two locations that would benefit from new health facilities were identified, regardless of scenarios. Due to the non-linear relationship between malaria incidence and prevalence, the optimal locations chosen based on the incidence criterion tended to be inequitable and was different from those based on the other optimisation criteria. Conclusions This study findings underscore the importance of using multiple optimisation criteria in the decision-making process. This analysis and the interactive application can be repurposed for other regions and criteria, bridging the gap between science, models and decisions.

scholarly journals Distribution of primary health care facilities in Mtwara District, Tanzania: availability and accessibility of services

1970 ◽  
Vol 20 (4) ◽  
Author(s):  
Irene R. Mremi ◽  
Mercy Mbise ◽  
Job A. Chaula
Keyword(s):  
Health Care ◽  
Health Facility ◽  
Low Income ◽  
Health Care Services ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Child Health Services ◽  
Healthy Population ◽  
Care Services ◽  
Care Facilities

Background: Access to health care services is a significant factor to health seeking practices that contributes to a healthy population. Improving health care accessibility is an important health priority in low-income countries. The objective of this study was to determine distribution of health care facilities and identify the high priority areas, which require more services in Mtwara, southern Tanzania.Methods: This study was carried in Mtwara Rural district of southern Tanzania and involved health care facilities. A hand held global positioning system was used to geo-reference the coordinates of all facilities. A questionnaire with both closed and open-ended questions was used to gather information from patients who attended the respective facilities. Interviews with district health officials and facility in-charges were conducted.Results:  There were 38 health in the district. Most of them were located within southern part of the district. The majority of facilities (97%) were government owned. On average each facility was serving 2,400 population. Malaria management, reproductive and child health services, family planning and integrated management of childhood illnesses were offered by all health facilities in the district. Prevention of mother to child transmission of HIV was offered by 34 (89.5%) facilities. Tuberculosis services were offered by only 3 facilities while voluntary counselling and testing of HIV and anti-retroviral treatment services were available in 15 and 10 health facilities, respectively. Only 4 facilities had laboratory and inpatients services. The majority of the staff included Medical Attendants (39%), Nurse Midwives (34%), and Clinical Officers (20%). Assistant Medical Officers and Nursing Officers each accounted for 2% of the total staff. There were no Medical Officers, laboratory technicians or pharmaceutical technicians in the district.  A total of 408 health facility clients (≥18yrs) were interviewed. Factors influencing the choice of a health facility were the availability of special services, medicine and qualified human resources.Conclusion: The majority of facilities in Mtwara are government and there is disparity in the distribution of the facilities. Availability of medicines and qualified human resources were the major factors on the preference for accessing health care services.

scholarly journals Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Quraish Sserwanja ◽  
David Mukunya ◽  
Milton W. Musaba ◽  
Joseph Kawuki ◽  
Freddy Eric Kitutu
Keyword(s):  
Mass Media ◽  
Health Facility ◽  
Health Survey ◽  
Low Income ◽  
Tertiary Education ◽  
Wealth Quintile ◽  
Northern Region ◽  
Health Facilities ◽  
Low Income Countries ◽  
Factors Associated

Abstract Background Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda. Methods We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49 years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25). Results The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8–77.5). The odds of women aged 15–19 years giving birth at health facilities were twice as those of women aged 40 to 49 years (adjusted odds ratio, AOR = 2.29; 95% CI: 1.71–3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR = 3.13; 95% CI: 2.15–4.56). Women with tertiary education (AOR = 4.96; 95% CI: 2.71–9.11) and those in the richest wealth quintile (AOR = 4.55; 95% CI: 3.27–6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare. Conclusion Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.

scholarly journals The Spectrum of Tuberculosis Disease in an Urban Ugandan Community and Its Health Facilities

2020 ◽  
Author(s):  
Emily A Kendall ◽  
Peter J Kitonsa ◽  
Annet Nalutaaya ◽  
K Caleb Erisa ◽  
James Mukiibi ◽  
...  
Keyword(s):  
Health Facility ◽  
Diagnostic Tests ◽  
Routine Care ◽  
Health Facilities ◽  
Local Health ◽  
Community Based ◽  
Pulmonary Tb ◽  
Mild Disease ◽  
Reactive Protein ◽  
Negative Controls

Abstract Background New, sensitive diagnostic tests facilitate identification and investigation of milder forms of tuberculosis (TB) disease. We used community-based TB testing with the Xpert MTB/RIF Ultra assay (“Ultra”) to characterize individuals with previously undiagnosed TB and compare them to those from the same community who were diagnosed with TB through routine care. Methods We offered community-based sputum Ultra testing to adult residents of a well-defined area (population 34 000 adults) in Kampala, Uganda, via door-to-door screening and venue-based testing, then used detailed interview and laboratory testing to characterize TB-positive individuals. We compared these individuals to residents diagnosed with pulmonary TB at local health facilities and a representative sample of residents without TB (controls). Results Of 12 032 residents with interpretable Ultra results, 113 (940 [95% confidence interval {CI}, 780–1130] per 100 000) tested positive, including 71 (63%) positive at the lowest (trace) level. A spectrum of TB disease was observed in terms of chronic cough (93% among health facility–diagnosed cases, 77% among residents with positive community-based Ultra results at levels above trace, 33% among trace-positive community participants, and 18% among TB-negative controls), TB symptom prevalence (99%, 87%, 60%, and 38%, respectively), and C-reactive protein (75th percentile: 101 mg/L, 28 mg/L, 6 mg/L, and 4 mg/L, respectively). Community-diagnosed cases were less likely than health facility–diagnosed cases to have human immunodeficiency virus coinfection or previous TB. The specificity of Ultra was 99.4% (95% CI, 99.2%–99.5%) relative to a single spot sputum culture. Conclusions People with undiagnosed prevalent TB in the community have different characteristics than those diagnosed with pulmonary TB in health facilities. Newer diagnostic tests may identify a group of people with early or very mild disease.

scholarly journals Event-based surveillance at health facility and community level in low-income and middle-income countries: a systematic review

2019 ◽  
Vol 4 (6) ◽  
pp. e001878 ◽  
Author(s):  
Anna Kuehne ◽  
Patrick Keating ◽  
Jonathan Polonsky ◽  
Christopher Haskew ◽  
Karl Schenkel ◽  
...  
Keyword(s):  
Public Health ◽  
Health Facility ◽  
Low Income ◽  
Surveillance Systems ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Routine Surveillance ◽  
Set Up ◽  
Event Based

BackgroundThe International Health Regulations require member states to establish “capacity to detect, assess, notify and report events”. Event-based surveillance (EBS) can contribute to rapid detection of acute public health events. This is particularly relevant in low-income and middle-income countries (LMICs) which may have poor public health infrastructure. To identify best practices, we reviewed the literature on the implementation of EBS in LMICs to describe EBS structures and to evaluate EBS systems.MethodsWe conducted a systematic literature search of six databases to identify articles that evaluated EBS in LMICs and additionally searched for grey literature. We used a framework approach to facilitate qualitative data synthesis and exploration of patterns across and within articles.ResultsWe identified 778 records, of which we included 15 studies concerning 13 different EBS systems. The 13 EBS systems were set up as community-based surveillance, health facility-based surveillance or open surveillance (ie, notification by non-defined individuals and institutions). Four systems were set up in outbreak settings and nine outside outbreaks. All EBS systems were integrated into existing routine surveillance systems and pre-existing response structures to some extent. EBS was described as useful in detecting a large scope of events, reaching remote areas and guiding outbreak response.ConclusionHealth facility and community-based EBS provide valuable information that can strengthen the early warning function of national surveillance systems. Integration into existing early warning and response systems was described as key to generate data for action and to facilitate rapid verification and response. Priority in its implementation should be given to settings that would particularly benefit from EBS strengths. This includes areas most prone to outbreaks and where traditional ‘routine’ surveillance is suboptimal.

scholarly journals Guiding placement of health facilities using malaria criteria and interactive tool

2021 ◽  
Author(s):  
Kok Ben Toh ◽  
Justin Millar ◽  
Paul Psychas ◽  
Benjamin Abuaku ◽  
Collins Ahorlu ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Malaria Incidence ◽  
Spatial Optimization ◽  
Malaria Prevalence ◽  
Health Facilities ◽  
Northern Ghana ◽  
Community Based ◽  
Optimization Criteria ◽  
Hypothetical Scenario

Abstract Background: Access to healthcare is important in controlling malaria burden and, as a result, distance or travel time to health facilities is often a significant predictor in modeling malaria prevalence. Adding new health facilities may reduce overall travel time to health facilities and may decrease malaria transmission. To help guide local decision makers as they scale up community-based accessibility, we explore how the allocation of new health facilities might influence malaria prevalence in Bunkpurugu-Yunyoo district in northern Ghana. We perform a location-allocation analysis to find optimal locations of new health facilities by minimizing three district-wide objectives separately: malaria prevalence, malaria incidence, and average travel time to health facilities. Methods: We used generalized additive model to model malaria prevalence as a function of travel time to health facility and other geospatial covariates. The model predictions are used to calculate the optimization criteria and to conduct spatial optimization. This analysis was performed for two scenarios: adding new health facilities to the existing ones, and a hypothetical scenario in which the community-based healthcare facilities would be allocated anew. We created an interactive web application to facilitate efficient presentation of this analysis and allow users to experiment with their choice of health facility location and optimization criteria. Results: Using malaria prevalence and travel time as optimization criteria, we found two locations that were not covered by existing community-based health services that would benefit from new health facilities, regardless of scenarios. Due to the non-linear relationship between malaria incidence and prevalence, the optimal locations chosen by using incidence criterion tend to be inequitable and are different from those based on the other optimization criteria. Conclusion: Our findings underscore the importance of using multiple optimization criteria in the decision-making process. We believe that our analysis and interactive application can be repurposed for other regions and criteria, bridging the gap between science, models and decisions.

scholarly journals Determinants of health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016

2020 ◽  
Author(s):  
Quraish Sserwanja ◽  
David Mukunya ◽  
Milton Musaba ◽  
Joseph Kawuki ◽  
Freddy Eric Kitutu
Keyword(s):  
Health Facility ◽  
Health Survey ◽  
Low Income ◽  
Rural Areas ◽  
Wealth Index ◽  
Northern Region ◽  
Health Facilities ◽  
Determinants Of Health ◽  
Facility Birth ◽  
Health Facility Birth

Abstract BackgroundAlmost all maternal deaths and other related morbidities occur in low income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the determinants of health facility utilization during childbirth in Uganda. MethodsWe used Uganda Demographic and Health Survey (UDHS) 2016 data of 10,152 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the determinants of health facility utilization during childbirth. All our analyses were done using SPSS version 25. ResultsThe proportion of women who gave birth from a health facility was 76.6% (7,780/10,152: (95% CI: 75.8-77.5). Odds of health facility birth decreased with older age. Women aged 15-19 years were twice as likely to give birth from health facilities compared to women aged 40 to 49 years (AOR=2.25; 95% CI: 1.71- 2.96). Women residing in urban areas were more likely to give birth from a health facility compared to those in rural areas (AOR=1.48; 95% CI: 1.18- 1.86), as well as those who attended ANC (AOR=3.60; 95% CI: 2.47- 5.24). Women in the Northern region were more likely to use health facilities compared to those in the Central region (AOR=2.42; 95% CI: 1.81- 3.22). Odds of health facility birth increased with rise in wealth index and education level. Women with higher education (AOR=5.15; 95% CI: 2.79- 9.52) and those in the richest wealth index (AOR=5.14; 95% CI: 3.72- 7.10) were five times more likely to give birth from a health facility compared to those with no education and those in the poorest wealth index respectively. ConclusionHealth facility utilization during childbirth was high and positively associated with; decreasing age, increasing level of education and wealth index, urban residence, Northern region and ANC attendance. We recommended that interventions to promote health facility childbirths in Uganda should target the poor, less educated and older women especially those residing in rural areas.

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