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Author(s):  
Maria Luisa Medina-Pizzali ◽  
Stella M. Hartinger ◽  
Gabriela Salmon-Mulanovich ◽  
Anika Larson ◽  
Maribel Riveros ◽  
...  

Antimicrobial resistance (AMR) in rural Latin America is not fully understood. The transmission pathways are partially known since research predominantly focuses on the urban hospital setting. The contribution to AMR from environmental factors is usually only mentioned in large-scale animal production. To understand the state of the literature on AMR in rural LA, we carried out a scoping review using the One Health (OH) perspective. OH recognises the concomitant contributions and interconnectedness of humans, animal, and the environment, thus, we used the OH perspective to select those articles adopting a holistic view of the problem. We searched original articles in English, Spanish, and Portuguese in four peer-reviewed databases and included 21 publications in the analysis. We charted data on bibliometrics, design, data collection sources, and instruments. We identified the human, animal, and environmental contributions to AMR in rural locations, and information gaps on AMR transmission routes and AMR drivers. Intensive and non-intensive animal production systems and agricultural practices were the most frequently found human contributions to AMR. Poultry, swine, cattle, and fish were the most frequent livestock mentioned as sources of AMR bacteria. Animal carriage and/or transfer of AMR determinants or bacteria was recognised as the primary contribution of livestock to the problem, while water, soil, and farming were predominant environmental contributions. We found that only 1 article out of 21 considered the OH approach as a framework for their sampling scheme, whereas 5 out 21 discussed all the three OH components. There were hardly any descriptions of humans or human waste as reservoirs for AMR in rural locations, and rural health centres or hospitals and wildlife were not represented. No studies identified mining as an anthropogenic activity driving AMR. More OH-oriented studies, with emphasis on molecular approaches—for identification and comparison of AMR genes—are sorely needed to understand better the existence of a network of interconnected transmission routes in rural Latin America and provide efficient strategies to prevent further AMR emergence.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mihretu Tarekegn ◽  
Habte Tekie ◽  
Sisay Dugassa ◽  
Yitbarek Wolde-Hawariat

Abstract Background Ethiopia embarked on combating malaria with an aim to eliminate malaria from low transmission districts by 2030. A continuous monitoring of malaria prevalence in areas under elimination settings is important to evaluate the status of malaria transmission and the effectiveness of the currently existing malaria intervention strategies. The aim of this study was to assess the prevalence of malaria and associated risk factors in selected areas of Dembiya district. Methods A cross-sectional parasitological and retrospective survey was conducted in the two localities of Dembiya District, selected based on their long standing history of implementing malaria prevention and elimination strategies. Thin and thick blood smears collected from 735 randomly selected individuals between October and December, 2018 were microscopically examined for malaria parasites. Six years (2012–2017) retrospective malaria data was collected from the medical records of the health centres. Structured questionnaires were prepared to collect information about the socio-economic data of the population. Logistic regression analysis was used to determine a key risk factor explaining the prevalence of malaria. The data were analysed using SPSS version 20 and p ≤ 0.05 were considered statistically significant. Results The 6-year retrospective malaria prevalence trend indicates an overall malaria prevalence of 22.4%, out of which Plasmodium falciparum was the dominant species. From a total of 735 slides examined for the presence of malaria parasites, 3.5% (n = 26) were positive for malaria parasites, in which P. falciparum was more prevalent (n = 17; 2.3%), Plasmodium vivax (n = 5; 0.7%), and mixed infections (n = 4; 0.5%). Males were 2.6 times more likely to be infected with malaria than females (AOR = 2.6; 95% CI 1.0, 6.4), and individuals with frequent outdoor activity were 16.4 times more vulnerable than individuals with limited outdoor activities (AOR = 16.4, 95% CI 1.8, 147.9). Furthermore, awareness about malaria transmission was significantly associated with the prevalence of malaria. Conclusions Malaria is still a public health problem in Dembiya district irrespective of the past and existing vector control interventions. Therefore, the authorities should work on designing alternative intervention strategies targeting outdoor malaria transmission and improving community awareness about malaria transmission and control methods in the study area. For this, continuous monitoring of vectors’ susceptibility, density, and behaviour is very important in such areas.


2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Alireza Mohammadi ◽  
Abolfazl Mollalo ◽  
Robert Bergquist ◽  
Behzad Kiani

Abstract Background There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran. Methods The 2021 age structure of the urban census tracts was integrated into the enhanced two-step floating catchment area model to improve accuracy. The model was developed based on three different access scenarios: only public hospitals, only public healthcare centres and both (either hospitals or healthcare centres) as potential vaccination facilities. The weighted decision-matrix and analytic hierarchy process, based on four criteria (i.e. service area, accessibility index, capacity of vaccination centres and distance to main roads), were used to choose potential vaccination centres looking for the highest suitability for residents. Global Moran’s index (GMI) was used to measure the spatial autocorrelation of the accessibility index in different scenarios and the proposed model. Results There were 26 public hospitals and 271 public healthcare centres in the study area. Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area, our findings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part. Therefore, a combination of public hospitals and public healthcare centres is recommended for efficient vaccination coverage. The value of GMI for the proposed model (accessibility to selected vaccination centres) was calculated as 0.53 (Z = 162.42, P < 0.01). Both GMI and Z-score values decreased in the proposed model, suggesting an enhancement in accessibility to COVID-19 vaccination services. Conclusions The periphery and poor areas of the city had the least access to COVID-19 vaccination centres. Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decision-makers. Our model, coupled with geographical information systems, provides more efficient vaccination coverage by identifying the most suitable healthcare centres, which is of special importance when only few centres are available. Graphic abstract


Author(s):  
Elizabeth Nionzima ◽  

Obstructed labour is a common preventable causes of both maternal and perinatal morbidity and mortality in developing countries affecting 3-6% labouring women globally and accounts for an estimated 8% of maternal deaths in Sub-Saharan Africa and South Asia. Objective: To determine the prevalence and outcome of obstructed labour in the Gynaecology and Obstetrics Department at a tertiary hospital in Northern Uganda. Method: This was a retrospective chart review of pregnant women admitted in labour and delivered by caesarean section from 1st January 2016 to 31st December 2017 at a Lira Regional Referral Hospital, a tertiary institution in Lango Sub region. Data was analysed using Statistical Package for Social Sciences version 16.0. Results: A total of 808 medical charts of mothers with obstructed labour were retrieved, evaluated and included in this review out of 12,189 deliveries during the study period, giving a prevalence of 6.6%. Majority (77%; 622/808) mothers admitted with diagnosis of obstructed were referred in from peripheral facilities. Over half (53.4%) of the women were in the age group of 20 to 29 years. Over 53%, were prime gravidae and were twice more likely to undergo C/S due to obstructed labour than multigravidas (OR 1.8; 95% CI 1.5-2.2). Only 49.2% had documented cause of obstructed labour, with Cephalo-pelvic disproportion being most common (17.5%), malposition/mal-presentation (14.6%), and macrosomia (3.6%). Partograph was used in only 46.6% (374) women who had obstructed labour. The commonest maternal complication observed were Sepsis (11%), PPH (5.2%), uterine rupture (4%) and burst abdomen (3%) which led to prolonged hospital stay and loss of fertility to some. Mode of delivery in the 808 reviewed charts was caesarean section, 90.3% of babies were born alive, while 8.5% (69) were born dead, (1.2%) had early neonatal, and 40.2% were referred Paediatric Neonatal Intensive Care Unit (NICU) because of low APGAR score. Conclusion: The prevalence of obstructed labour among women delivered by Caesarean section was high compared to the global average. Majority of the women were referrals from the peripheral health centres and associated with life threatening complications and even death. Young age and prime gravida is associated with obstructed labour and high caesarean section rates. The obstruction in multigravida could be due to secondary cephalo-pelvic disproportion as majority of the babies were in normal range weight. Low use of Partograph to monitor labour was evident among women who had obstructed.


2021 ◽  
pp. archdischild-2021-321993
Author(s):  
Kamal Ibne Amin Chowdhury ◽  
Ishrat Jabeen ◽  
Mahfuzur Rahman ◽  
Abu Syed Golam Faruque ◽  
Nur H Alam ◽  
...  

ObjectiveDelays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.MethodsWe conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.ResultsWe found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.ConclusionsThis study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.


2021 ◽  
Author(s):  
Janet Kemei ◽  
Josephine Etowa

Abstract BackgroundMaternal mortality in low middle-income countries is still high. Like most countries in Sub-Saharan Africa, the progress towards reducing maternal mortalities in Kenya is slow. Approximately 488 women out of every 100,000 live births die during the childbearing process. Kenya has put in place several strategies to mitigate maternal mortalities. For instance, Kenya introduced free maternity services in 2013 to remove financial barriers to skilled health services for mothers and children under five years old. Hence, it is necessary to explore how the policies and infrastructure intersect with other socioeconomic factors to influence postpartum care in rural Kenya to mitigate maternal and infant deaths.MethodsThis qualitative research conducted in-depth focused ethnographic (FE) interviews with 23 nurses and midwives working in nine health centres and the County Hospital in Nandi County, Kenya, between July 2017 and February 2018. We used thematic analysis approach as described by Braun and Clarke to analyze the data. Lincoln and Guba criteria for establishing the trustworthiness of data was used. ResultsThe analysis of data generated six themes. The findings from the theme, Policies and Infrastructure Influencing Postpartum Care will be discussed in this paper. The findings will be discussed under three sub-themes 1) Free maternity services, 2) Adherence to perinatal care guidelines, and 3) Recruitment and retention of nurses and midwives. Facilities lacked the essential equipment and supplies required to provide these services, recruitment and retention of staff, demotivation of healthcare providers, lack of regular training and supervision of staff, and lack of adherence to postpartum guidelines. These issues intersected to determine the quality of skilled postpartum services provided to childbearing women and their families as well as women and infants’ overall perinatal health outcomes. ConclusionThe findings have underscored the importance of having a functional healthcare system that supports both the clinical and emotional aspects of the women and healthcare providers. Efforts should be directed into addressing the negative factors influencing care provision at the facility level. Suboptimal care could cause women not to attend skilled health care and sabotage the global goals of eliminating maternal and infant mortalities. This can be achieved by creating policies that considers the diverse causes and power-relations withing the healthcare organization.


2021 ◽  
Author(s):  
Tine Nesbø Tørseth ◽  
Marian Ådnanes

Abstract Background: In January 2019, the official launch of new guidelines within specialist mental health services and substance abuse treatment in Norway took place, with treatment organized according to structured patient pathways. The pathway system introduced maximum lengths for assessment, treatment, and evaluation and the coding of the different steps. The system was based on overall goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, more equal services independent of geographic location, and greater emphasis on somatic health and lifestyle. The purpose of our study was to examine the implementation of patient pathways within mental health services, and more specifically how trust emerges and influences the final outcome. Methods: Our study included four outpatient clinics for adults in four community health centres in different parts of Norway. The informants consisted of treatment personnel, leaders, and pathway coordinators, and data were collected through qualitative group and individual interviews. Results: The results indicated four distinct themes or reactions towards the patient pathway system. These themes were unclarity regarding the overall goals and content of the patient pathway; increased coding, registration and administrative work, which professionals experienced as stressors; an IT and journal system that did not correspond with the coding of the patient pathway; and an unrealistic distinction between assessment and treatment. All of the above encouraged health professionals to reduce the importance of patient pathways, as well as increase their resistance towards health authorities. Conclusions: To understand how and why health professionals made sense of the patient pathway, theory on trust can be used to show how professionals within health care interpret the implementation of patient pathways as a desire to control more areas and work practices within mental health care, leading to their distrust towards the new system Trial registration: Not neccessary


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lorine Pelly ◽  
Kanchan Srivastava ◽  
Dinesh Singh ◽  
Parwez Anis ◽  
Vishal Babu Mhadeshwar ◽  
...  

Abstract Background In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak. Methods Secondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed. Results The median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016. Conclusions Facility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.


2021 ◽  
pp. archdischild-2020-321031
Author(s):  
Karen Blackmon ◽  
Roberta Evans ◽  
Michelle Fernandes ◽  
Barbara Landon ◽  
Trevor Noel ◽  
...  

ObjectiveZika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.DesignCohort study.SettingPublic health centres in Grenada, West Indies.Patients384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measuresThe INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.ResultsA total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.ConclusionsOverall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.


2021 ◽  
Author(s):  
Kapil Madi Poudel ◽  
Neha Shah ◽  
Manab Prakash ◽  
Santosh Kumar Deo ◽  
Sunita Bhandari ◽  
...  

Abstract Background: Vaccination is the most effective method to prevent the spread of infectious diseases and helps reduce mortality rate and economic costs associated with the pandemic. Despite these advantages, misinformation and rumors on vaccine safety and efficacy can lead to increased hesitation or fear towards vaccination. This study reports the incidence of adverse events following Covishield vaccination, their associated factors, medication used for their management, and attitudes about vaccine safety. Methods: A randomised cross-sectional study was conducted from the sample of Covishield-vaccinated individuals from a secondary hospital, two primary health centres, and 36 health posts in eastern Nepal. Individuals (n = 602) were randomly sampled from a population (N = 1013) who had received the first dose of Covishield, namely frontline workers and other high-risk populations. The second-round follow-up had 516 participants. Association of incidence and severity of post-vaccination events with socio-demographic variables, comorbidity status, and medication use were estimated. Results: Among the 79.9% of participants who reported adverse events after receiving the first dose, two-thirds of complaints were mild (67.4%, 95% CI 63.2–71.6) with the most common complaint being pain at the injection site (86.5%). Paracetamol or its combination were used in majority cases (95.2%). After the second dose, only 31.2% (95% CI 27.2–35.2) reported adverse events, the overwhelming majority of which were mild (95.7%) and required a lower frequency of medication (7.4% vs. 25.9%). Adverse Event following immunization were significantly associated with being 18–30 years old (χ2 = 16.9, df = 3, p < 0.001) and female gender (χ2 = 5.2, df = 1, p < 0.05). Prior to the first dose, 86.0% of participants (95% CI 83.3–88.8%) perceived the vaccine to be safe, and 96.0% recommended the vaccine post-vaccination, while 96.8% were interested in receiving the second dose.Conclusions: Overall, vaccination associated events were mild and majority were managed with paracetamol or its combination. Effective counselling about adverse events before vaccination should be prioritised to reduce hesitation and fear.


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