ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.

ELDERLY SATISFACTION TOWARDS THE INTEGRATED HEALTH POST (ES-IHP) QUESTIONNAIRES: VALIDATION USING RASCH MODELING

Integrated Health Post for the elderly (Posbindu) has been carried out to improve the health status of the elderly, but Posbindu’s utilization is still unsatisfactory. Satisfaction of the elderly towards the health care provided at the Posbindu contributed to their adherence. So far there is no instrument to measure the level of elderly satisfaction. The objectives of the study were to develop and assess the validity and reliability of the elderly satisfaction towards the integrated health post questionnaire using Rasch modeling. A cross-sectional study was carried out on 202 elderly from 16 Posbindu in Bandung, Indonesia. This study was performed from August to December 2019. The questionnaire was developed from a qualitative study, consisted of 36 items that covered the satisfaction concepts of structure, process, and output. Nine analytic tests were carried out, namely, the person fit order, person reliability, Cronbach's alpha, item reliability, item fit order, separation, the Wright map analysis, rating scale, and the differential item functioning as implemented by the Winstep version 3.73 software. Overall, the questionnaire demonstrated promising results. The overall value of person reliability was 0.93 with Cronbach's alpha of 0.96 and the value of item reliability was 0.94. However, 3 items were misfits and should be considered to be revised or removed. Further studies involving various regions in Indonesia should be carried out before this questionnaire is used in Indonesia

Inovasi Pelaksanaan Posyandu Selama Masa Pandemi Covid-19: Studi Kualitatif di Wilayah Kerja Puskesmas Campalagian

Posyandu cadres play an important role in assisting Public Health Center in carrying out the functions of implementing health efforts and have a strategic position to prevent stunting problems, especially in time the Covid-19 pandemic. This study aimed to describe the implementation of Integrated Health Post (Posyandu) in the working area of ​​the Campalagian Health Center during the Covid-19 pandemic in 2020. This study qualitative used a phenomenology approach which was carried out in the working area of ​​the Campalagian Health Center in July - September 2020. A total of 10 Posyandu cadres were the main informants. Data were collected through in-depth interviews for 60 – 90 minutes conducted at the homes of Posyandu cadres while still paying attention to health protocols. Cadres did not carry out Posyandu in April and May 2020 following local government regulations or in certain months when there was an increase in cases of Covid-19 in the area. In implementing the Posyandu during the pandemic, cadres made several innovations such as setting up emergency handwashing facilities, arranging visit schedules, and the distance of waiting chairs at the Posyandu, requiring them to bring their own sharoong from home for weighing toddlers and disinfecting the Posyandu room. In conclusion, cadres make innovations in the implementation of Posyandu during the pandemic such as preparing emergency hand washing facilities, arranging visit schedules and waiting chair spacing at Posyandu, requiring them to bring their own gloves and disinfecting the Posyandu room. The implementation of Posyandu during the Covid-19 pandemic can prevent an increase in nutritional problems in mothers and stunting problems in toddlers. Therefore, the local government is expected to support the implementation of Posyandu routinely such as ensuring the availability of PPE for posyandu cadres, mothers and toddlers. So that Posyandu can still be implemented while still observing health protocols.

Time to Recovery and Determinants of Uncomplicated Severe Acute Malnutrition Among 6–59 Months Children From the Outpatient Therapeutic Feeding Program in North Shewa Zone of Oromia Region, Ethiopia. A Prospective Follow-Up Study.

Introduction: Community-based management of acute malnutrition is implementing in Ethiopia. But there is scarce information in our study set up regarding the time to recovery and its predictors of SAM among 6-59 months children, so this study aimed to assess the time to recovery and its predictors of uncomplicated SAM among 6-59children managed at the OTP in north Shewa zone, Ethiopia.Methods: A health post-based prospective follow-up study had conducted on 6-59months children from November 20/2020 – February 20/2021. A total of 423 children had included in the study. A structured interviewer-administered questionnaire had used. The median time to recovery had calculated using the Kaplan Meier (KM) curve. The predictors of time to recovery were determined using both bi-variable and multi-variable Cox regression models with a 95% confidence interval (CI). Finally, the variable that had a p-value < 0.05 in the multi-variable analysis was declared as the predictors of time to recovery. Proportional hazard assumption was checked graphically and using Schoenfeld residual test.Result: From the total 423 Children, 327 (77.3%) recovered. The median time to recovery was 42 + IQR of 14 days. Children from food secure households; AHR= 9.6 with 95% CI (8.1-18.5), mild food insecure; AHR= 6.5 with 95% CI (3.1, 13.8), moderate food insecure; AHR= 2.5 with 95% CI (1.2-5.3). Mothers who traveled less than 2 hours walking distance to the health post; AHR=2.6 with 95% CI (1.8-18.7). Children who received the correct dose of the RUTF AHR=1.6 with 95% CI (1.1-2.3), children who measured their weight weekly AHR= 1.5 with 95% CI (1.1-2.0), and children treated by health extension worker who took the Nutrition-related training AHR= 2.1 with 95% CI (1.0-4.5) were predictors of time to recovery. Conclusion and recommendation: The median time to recovery was within the acceptable range of the Ethiopian protocol for the management of uncomplicated SAM in the Outpatient setup. Household food security status, the distance between home and health posts, the correct dose of RUTF, weekly weight measurement per protocol, and HEWs nutrition-related training status were the significant predictors of time to recovery. It is advisable to improve the household food security status, and the Health extension worker's (HEWs) nutrition-related training.

ICU-Acquired Pneumonia is a Risk Factor of a Poor Health Post-Covid-19 Syndrome

Background. Some patients who had previously presented with COVID-19 have been reported to develop persistent COVID-19 symptoms. Whilst this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the prevalence and risk factors and characteristics of persistent COVID_19 . On other hand these patients have very often intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence in the poor health post-Covid 19 syndrome in ICU discharged patientsMethods: This prospective, multicentre and observational study was done across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1,255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP) Patients requiring invasive mechanical ventilation had persistent, post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, and development of ICUAP were independent risk factors for persistent poor health post-COVID-19.Conclusions: Persistent, post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay and the onset of ICUAP comprised all independent risk factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-Covid 19

Development and Evaluation of a Community Surveillance Method for Estimating Deaths Due to Injuries in Rural Nepal

Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.

Empowerment of Integrated Health Post Cadres through Fish Nugget Processing to Prevent Anemia in Pregnant Women

Fish is a source of nutrition that is cheap and easy to get, especially in Jember Regency. One of the health problems experienced by teenage girls and pregnant women is anemia. Anemia can be prevented by consuming adequate and diverse nutrients. However, the society at Darungan Dusun (Dusun is lower than the village in Indonesia's administrational hierarchy) did not know how to make exciting and not boring processed food. Fish nugget is creations from tuna or catfish to increase fish consumption coverage in society. This activity was carried out in the Integrated Health Post at Darungan Dusun Kemuning Lor Village, Jember Regency. There were fourteen of the integrated health post cadres and pregnant women who participated in this activity. Community service methods used demonstrations and counseling. The counseling and demonstration of fish nugget processing improve knowledge in Integrated Health Post cadres and pregnant women. Furthermore, it can prevent anemia in pregnant women. There should be support and participation from the local government for the sustainability of this activity.

Barriers to the uptake of community-based curative child health services in Ethiopia

Background Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. Methods Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. Results Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. Conclusion This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.