Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi. Methods We use data from the 2016–2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth. Results Occupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. Conclusions In Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.

Cancer: New Needs, New Models. Is It Time for a Community Oncologist? Another Brick in the Wall

Over the last few decades, thanks to early detection, effective drugs, and personalized treatments, the natural history of cancer has radically changed. Thanks to these advances, we have observed how survival of cancer patients has increased, becoming an ever more important goal in cancer care. Effective clinical governance of survivorship care is essential to ensure a successful transition between active and post-treatment life, identifying optimization of healthcare outcomes and quality of life for patients as the primary objectives. For these reasons, potential intervention models must consider these differences to rationalize the available resources, including economic aspects. In this perspective, analyzing the different models proposed in the literature to manage this type of patients, we focus on the possible role of the so-called “community oncologist”. As a trained health professional, also focused on longevity, he could represent the right management solution in all those “intermediate” clinical conditions that arise between the hospital specialist, frequently overworked, and the general practitioner, often biased by the lack of specific expertise.

Empirical Analysis of Socio-Economic Determinants of Maternal Health Services Utilisation in Burundi

BackgroundTimely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.MethodsWe use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth. ResultsOccupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. ConclusionsIn Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

Throat wash as a source of SARS-CoV-2 RNA to monitor community spread of COVID-19.

Background: SARS-CoV-2 RNA detection with real time PCR is currently the central diagnostic tool to determine ongoing active infection. Nasopharyngeal and oral swabs are the main collection tool of biological material used as the source of viral RNA outside a hospital setting. However, limitation in swabs availability, trained health professional with proper PPE and potential risk of aerosols may hinder COVID diagnosis. Self-collection with swabs, saliva and throat wash to obtain oropharyngeal wash has been suggested as having comparable performance of regular swab. We performed throat wash (TW) based surveillance with laboratory heath workers and other employees (LHW) at a laboratory research institute. Methods: Consecutive volunteer testing of LWH and external household and close contacts were included. TW self-collection was performed in 5 mL of sterile saline that was returned to original vial after approximate 5 secs of gargle. RNA extraction and rtPCR were performed as part of routine COVID protocols using Allplex (Seegene, Korea). Results: Four hundred and twenty two volunteers, 387 (93%) LHW and 43 (7%) contacts participated in the survey. One or more positive COVID rtPCR was documented in 63 (14.9% CI95 12%-19%) individuals. No correlation was observed between with direct activities with COVID samples to positivity, with infection observed in comparable rates among different laboratory areas, administrative or supportive activities. Among 63 with detected SARS-CoV-2 RNA, 59 with clinical information, 58% reported symptoms at a median of 4 days prior to collection, most with mild disease. Over a third (38%) of asymptomatic cases developed symptoms 1-3 days after collection. Although overall CT values of TW were higher than that of contemporary swab tests from hospitalized cases, TW from symptomatic cases had comparable CTs. Conclusions: The study suggests that TW may be a valid alternative to the detection of SARS-CoV-2 RNA. The proportion of asymptomatic and pre-symptomatic cases is elevated and reinforces the need of universal precautions and frequent surveys to limit the spread of the disease.

Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods We use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth.Results Occupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions In Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

The real business of health care

THIS ISSUE CONTAINS papers that consider some of the complex issues within human resource management (HRM) in health care. In health systems the care provided has tended to be craftbased production ? a trained health professional provides his or her craft for individual patients, with little need for management. Influencing the relationship between practitioner and patient has been limited by professional autonomy and the different cultures that exist among the specialised health professional groups. These differences are illustrated by Perkins et al by the results of a survey of starting and finishing undergraduate medical, nursing and pharmacy students (page 252).

Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective, and Practical Alternative

Mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue.