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2021 ◽  
Vol 18 (1) ◽  
Farzana Maruf ◽  
Hannah Tappis ◽  
Enriquito Lu ◽  
Ghutai Sadeq Yaqubi ◽  
Jelle Stekelenburg ◽  

Abstract Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.

Abhishek Sharma ◽  
Sarita J. Bhyan ◽  
Abdul Malik

This review article overviewed briefly about the era of deadly viruses. Humans have been combating viruses since before our species had even evolved into its recent form. In some cases of viral infections, vaccines and antiviral drugs have allowed us to treat infections from spreading broadly, and have facilitated to patient recover. But it is far from over to fight the viruses. In recent decades, a number of viruses have sprung from animals to humans and have caused massive outbreaks, claiming thousands of lives such as the virus that led to the 2014-2016 Ebola outbreak in West Africa kills up to 90% of the population, making it the deadliest member of the Ebola family. But there are some viruses that are equally deadly, and some are even more deadly. Some viruses, including the novel coronavirus currently undergoing global outbreaks, have a low mortality rate but still pose a serious health risk as we have no means of access to the health facilities and scarcity of resources and infrastructure. Here we are reporting such type of ten deadly viruses. those have infected humans within last 50 years.

2021 ◽  
Yashwant Deshmukh ◽  
Wilson Suraweera ◽  
Chinmay Tumbe ◽  
Aditi Bhowmick ◽  
Sankalp Sharma ◽  

Background: India's official death totals from the COVID pandemic are widely regarded as under-reports. Methods: We quantified all-cause excess mortality in India, comparing deaths during the peak of the first and second COVID waves (Jul-Dec 2020 and April-June 2021) with month wise deaths in 2015-19 from three sources: Civil Registration System (CRS) mortality reports from 15 states or cities with 37% of India's population; deaths in 0.2 million health facilities; and a representative survey of 0.14 million adults about COVID deaths. Results: During the first viral wave, the median excess mortality compared to CRS baseline was 22% and 41%, respectively, in included states and cities, rising to 46% and 85% during the second wave. In settings with 10 or more months of data across the two waves, the median excess mortality was 32% and 37% for states and cities, respectively. Deaths in health facilities showed a 27% excess mortality from July 2020-May 2021, reaching 120% during April-May 2021. The national survey found 3.5% of adults reported a COVID death in their household in April-June 2021, approximately doubling the 3.2% expected overall deaths. The national survey showed 29-32% excess deaths from June 1, 2020 to June 27, 2021, most of which were likely to be COVID. This translates to 3.1-3.4 million COVID deaths (including 2.5-2.8 million during April-June 2021). National extrapolations from health facility and CRS data suggest 2.7-3.3 million deaths during the year. Conclusions: India's COVID death rate may be about 7-8 times higher than the officially reported 290/million population.

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254214
Henry Zakumumpa ◽  
Kimani Makobu ◽  
Wilbrod Ntawiha ◽  
Everd Maniple

Introduction Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models. Methods Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach. Results Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models. Conclusion To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254561
Kiran Acharya ◽  
Raj Kumar Subedi ◽  
Sushma Dahal ◽  
Rajendra Karkee

Background Achieving maternal and newborn related Sustainable Development Goals targets is challenging for Nepal, mainly due to poor quality of maternity services. In this context, we aim to assess the Basic Emergency Obstetric and Newborn Care (BEmONC) service availability and readiness in health facilities in Nepal by analyzing data from Nepal Health Facility Survey (NHFS), 2015. Methods We utilized cross-sectional data from the nationally representative NHFS, 2015. Service availability was measured by seven signal functions of BEmONC, and service readiness by the availability and functioning of supportive items categorized into three domains: staff and guidelines, diagnostic equipment, and basic medicine and commodities. We used the World Health Organization’s service availability and readiness indicators to estimate the readiness scores. We performed a multiple linear regression to identify important factors in the readiness of the health facilities to provide BEmONC services. Results The BEmONC service readiness score was significantly higher in public hospitals compared with private hospitals and peripheral public health facilities. Significant factors associated with service readiness score were the facility type (14.69 points higher in public hospitals, P<0.001), number of service delivery staff (2.49 points increase per each additional delivery staff, P<0.001), the service hours (4.89 points higher in facilities offering 24-hour services, P = 0.01) and status of periodic review of maternal and newborn deaths (4.88 points higher in facilities that conducted periodic review, P = 0.043). Conclusions These findings suggest that BEmONC services in Nepal could be improved by increasing the number of service delivery staff, expanding service hours to 24-hours a day, and conducting periodic review of maternal and newborn deaths at health facilities, mainly in the peripheral public health facilities. The private hospitals need to be encouraged for BEmONC service readiness.

2021 ◽  
Abigiya Wondimagegnehu ◽  
Workeabeba Abebe ◽  
Selamawit Hirpa Abu ◽  
Eva J. Kantelhardt ◽  
Adamu Addissie ◽  

Abstract Purpose: Although psychosocial services have substantial impact in cancer care, the availability and utilization of these services have not been well-studied in Sub Saharan Africa. Therefore, we explored the types of psychosocial services available for breast cancer patients in Addis Ababa, Ethiopia.Methods: A mixed method study was conducted using a cross-sectional survey involving 428 breast cancer patients, followed by a qualitative study. A total of nine in-depth interviews (IDIs) were conducted with four breast cancer patients and five key informants using two separate interview guides. In addition to descriptive statistics, logistic regression was done to identify factors associated with provision of psychosocial services. Thematic analysis was used for the qualitative data using NVivo 12 plus software. Results: Only 47 (11.1%) patients received psychosocial services, either in the form of counseling, emotional support or provision of information. Health professionals reportedly provided such services along with their routine activities, and patients predominantly received social/emotional support from family members, friends and colleagues. There were no well-structured counseling service, emotional support or group discussion sessions for breast cancer patients in these health facilities. The main reasons for not providing these services were high patient flow/workload, inadequate space, lack of training and not having qualified professionals to organize and deliver psychosocial services in those hospitals.Conclusions: only one in ten breast cancer patients received psychosocial services from health professionals, and the services were not delivered in a structured way. Therefore, psychosocial services should be integrated both in private and government health facilities of Ethiopia.

Juliet Mwanga-Amumpaire ◽  
Tobias Alfvén ◽  
Celestino Obua ◽  
Karin Källander ◽  
Richard Migisha ◽  

In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.

Lorna Ferguson

Missing person reports from hospitals and mental health facilities are a significant issue impacting patients, communities, and health and police sectors. Research on missing persons seldom considers the type of location from where people go missing, which can be troublesome due to the increased chances for experiencing harm during an episode from hospitals and mental health facilities. When location type is studied, these often remarkably different places are frequently blended together in analyses and discussions. This conflation has implications for research and the development of effective police preventive responses. To begin to address this gap, this study uses descriptive analysis and logistic regression to examine the descriptive and predictive profiles of those reported missing from hospitals versus those reported missing from mental health units. For this, data are taken from a sample of 916 closed missing person cases reported to a Canadian municipal police service over five years. Results suggest there are significant differences in both the descriptive and predictive profiles of individuals reported missing from these two location types, such as individuals with varying mental health and cognitive issues going missing from each place, respectively. Given the findings, the implications for research, policing, and risk management are discussed.

2021 ◽  
Vol 3 (1) ◽  
pp. 78-96
Jane Muthoni Njoroge ◽  
Priscillah Njeri Kabue ◽  
James Ochieng

Pressure ulcers are a common health problem in hospitalized patients, especially among patients with chronic illnesses and those with reduced mobility. The prevalence of pressure ulcers varies with health care settings and is highest in critically ill patients ranging between 15-20%. They affect the quality of life of patients and caregivers and have been associated with heavy financial burdens, extended hospital stays, higher morbidity and mortality. Inadequate prevention measures and lack of active management of pressure ulcers in early stages especially in high-risk patients result in recurrence and complicated pressure ulcers. In view of this, a descriptive cross-sectional study was conducted in Murang’a County, Kenya in selected health facilities with the objective of determining the management of patients with pressure ulcers. The study population was composed of one hundred and twenty-four (124) nurses working in medical and surgical wards in selected health facilities. Semi-structured questionnaires, observational checklists and focused group discussions were used to collect data. The qualitative data from the focus group discussions and observational checklist were transcribed and a summary written. The relationship between nurse’s knowledge, nurse-oriented factors and institutional factors affecting management of pressure ulcers among nurses were examined using Pearson correlation analysis and multiple regression analysis. The median age of the respondents was 37 years with at least 112 (90.3%) having diploma level of education, and 63 (50.9%) were from the medical department. The majority of the nurses (93.6%) agreed pressure ulcers can be avoided, while 58.1% preferred pressure ulcer risk assessment tools compared to 27.5% who preferred clinical judgment in the management of pressure ulcers. The majority of nurses (87.5%) who had adequate knowledge on the management of pressure ulcers mentioned immobility and bedridden patients, stroke, spinal injury, dry skin, stool and urine incontinence as major contributors to pressure ulcers. Regarding pressure ulcer risk assessment, 62.9% of nurses assessed patients for pressure ulcers though they relied on clinical judgement as 93.9% indicated there was no risk assessment scale in the wards and 5.1% were not sure. On institutional factors 61.3% of the nurses indicated that health facilities were lacking pressure ulcer reducing devices and those that had pillows and a few ripple mattresses. Regarding guidelines in the management of pressure ulcers, 75.8% of nurses indicated they were not available in the hospital. The study found an association between age and knowledge increasing the odds of effective management age (AOR = 6.83, p = 0.001); experience (AOR = 4.08, p = 0.01), and education (AOR = 22.9, p = 0.000). The nurse-oriented factors increasing the odds of effective management of pressure ulcers include nurse’s positive attitude on prevention of pressure ulcers (AOR = 2.3, p = 0.040) and nurse use of pressure ulcer risk assessment tool (AOR = 4.3, p = 0.010). On institutional factors, nurses trained on management of pressure ulcers were 4.47 times likely to effectively manage patients with pressure ulcers. Nurses who lack in-service training about pressure ulcers were less likely to effectively manage patients with pressure ulcers (AOR = 0.11, p = 0.000).  The study concludes that the nurses had adequate knowledge in management of pressure ulcers, the nurses-oriented factors and institutional factors also influence the management of pressure ulcers

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