Satisfaction about Patient-centeredness and Healthcare System among Patients with Chronic Multimorbidity

The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system.Cross-sectional data on 18696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization(WHO).Outcome variables were subjective rating of(1)healthcare system's ability to involve patients in decision-making,and(2)satisfaction with the way healthcare system runs in the country.Self-reported chronic conditions were used to measure the prevalence of multimorbidity.Out of 9 chronic conditions,back pain,arthritis,and chronic cough appeared to be the most prevalent ones among majority of the participants.About one-third of the participants in China(30.7%)and two-thirds in Bangladesh(66.1%)and India(66.6%)reported having at least one chronic illness.Prevalence of multimorbidity was highest in India(34.3%)followed by Bangladesh(28.8%)and China(14.3%).In Bangladesh,India and China,respectively 70.5%,41.7%,61.3%women and 54.5%,42.8%and 58.8%men expressed dissatisfaction regarding the way healthcare system runs in their country.In Bangladesh and India,men who were living with multimorbidity were more likely to rate the patient-centeredness as"bad"than those who had no disease illness.This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India.Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.

Canada’s role in strengthening global health security during the COVID-19 pandemic

The world is confronted by the current pandemic of Corona Virus Disease(COVID-19),which is a wake-up call for all nations irrespective of their development status or geographical location.Since the start of the century we have seen five big infectious outbreaks which proved that epidemics are no more regarded as historic and geographically confined threats.The Canadian government underlined that these infectious disease outbreaks are threats to global health security and disrupt societal wellbeing and development.In this context,the Public Health Agency of Canada is proactive and has shown its preparedness for outbreaks of emerging and epidemic-prone diseases,and in dealing with these pathogens.Even before the declaration of pandemic,Canada has proved its global health leadership by ensuring collective action and multisectoral coordination which still remains a serious challenge especially for low and middle-income countries with existing poor health systems.In this article we discuss how Canada is addressing the global challenges posed by the COVID-19 pandemic through its leadership and practice of global health diplomacy.

Increasing women’s access to skilled pregnancy care to reduce maternal and perinatal mortality in rural Edo State,Nigeria:a randomized controlled trial

Background:Nigeria presently has the second highest absolute number of maternal deaths and perinatal deaths(stillbirth and neonatal deaths)in the world.The country accounts for up to 14%of global maternal deaths and is second only to India in the number of women who die during childbirth.Although all parts of the country are worsened by these staggering statistics,several lines of evidence show that most maternal,and perinatal deaths occur in the north-east and north-west geo-political zones where women have limited access to evidence-based maternal and neonatal health services.The proposed project intends to identify the demand and supply factors that prevent women from using PHCs for maternal and early new-born care in Nigeria,and to test innovative and community relevant interventions for improving women’s access to PHC services,and thus,ultimately,to prevent maternal and perinatal deaths.Methods:An open-labelled,randomized controlled trial will is carried out in two local government areas selected based on three criteria(i)maternal mortality rates(ii)PHC utilization rates and(iii)and geographic localization.The study will be conducted over 54-months in six communities,with PHCs in six communities of similar status serving as control sites.Surveys about quality of care and maternal health services utilization will be carried out at baseline,at midterm and at end of the project to test the effectiveness of the intervention,alongside conventional epidemiological measures of maternal and perinatal mortality.Ethical approval for the study has been granted(reference no.NHREC/01/01/2007).The findings will be published in compliance with reporting guidelines for randomized controlled trials.Discussion:The current Federal Government in Nigeria has identified PHC as its main strategy for increasing access to health in Nigeria.However,despite numerous efforts,there are persisting concerns that there is currently no scientific evidence on which to base the improvement of PHCs.The results of this study will identify barriers in the use of PHCs and will provide scientific evidence for effective and innovative interventions for improving PHCs that can be rolled out throughout the country.

What does women’s empowerment have to do with malnutrition in Sub-Saharan Africa?Evidence from demographic and health surveys from 30 countries

Background:The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries.The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development,labour supply,productivity,economic growth and development.This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries.Methods:The study utilized secondary datasets of women in their child bearing age(15-49 years)from the latest Demographic and Health Survey(DHS)conducted in 2011-2017 across 30 sub Saharan Africa countries.The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence.Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status.Results:Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status(stunted and underweight)at p<0.001.These characteristics were also statistically significantly associated with empowerment status of women(Decision-making,Violence attitudes and Experience of violence)at p<0.001 except for child age and sex.The association between childhood nutritional statuses and women’s empowerment(all three empowerment measures)was significant after controlling for other covariates that could also influence childhood nutrition statuses at p<001.Two of the empowerment measures(attitudes towards violence and experience of violence)showed positive association with childhood nutritional statuses while the third(decision-making)showed negative association.Conclusion:There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries.Women’s empowerment was found to be related to childhood nutritional status.Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.

Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries

Background:Access to safe Cesarean section(C-section)in resource-constrained settings such as sub-Sahara Africa(SSA)region is a foremost approach to reduce maternal mortality.C-section is an obstetric operative procedure used appropriately to improve delivery outcomes.However,errors in the procedure have enormous potential harm that may outweigh the benefits.This study assessed the prevalence and determinants of C-section in several SSA countries.This study examined the prevalence and determinants associated with cesarean delivery in SSA countries.Methods:Secondary data of women of reproductive age(15-49 years)from the current Demographic and Health Survey(DHS)in 34 SSA countries was utilized in this study.The mode of delivery among women was the primary outcome variable.Percentage and descriptive statistics were used to conduct univariate analyses.Furthermore,multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women.Results:Results showed disparities in the percentage of C-section among women from 34 SSA countries.C-section at public healthcare settings ranged from 3%in Burkina Faso to 15.6%in Ghana.However,in private healthcare settings,C-section ranged from 0%in Sao Tome and Principe to 64.2%in Rwanda.Overall,C-section was 7.9%from public healthcare and 12.3%from private healthcare facilities respectively.In the adjusted regression model;women aged 35-49 had increase in the odds of C-section,while a unit increase in the number of children ever born had 17 and 20%significant reduction in the odds of C-section in public and private healthcare respectively.Assessing public healthcare settings;women from richer/richest households,male and large size children at birth had increase in the odds of C-section,while those from rich neighbourhood had reduction in the odds of C-section.In private healthcare settings,women with high decision making power and multiple births had increase in the odds of C-section,while those who attended ANC visits had significant reduction in the odds of C-section.Conclusion:The findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care.Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings.Also training of medical personnel including midwives and nurses in emergency obstetric care,ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.

Trends in the prevalence and care-seeking behaviour for acute respiratory infections among Ugandan infants

Background:Acute Respiratory Infections(ARIs)as a group of diseases/symptoms constitute a leading cause of pediatric morbidity and mortality in sub-Saharan Africa where over 10%of all children die before reaching their fifth birthday.Although the burden of ARIs is highest in the African countries,there is little evidence in the current literature regarding their prevalence and treatment seeking.The objective of this study was therefore to assess the secular trend in the prevalence of ARIs as well as their treatment seeking-behaviour among Ugandan infants.Methods:This cross-sectional study was based on data from Uganda Demographic and Health Surveys(conducted between 1995 and 2016)on 26,974 singleton infants aged 0-5 months.Mothers(aged 15-49 years)were interviewed to collect information on the prevalence of recent occurrences of fever,cough and dyspnea.The adjusted trend in the prevalence and predictors of ARIs and care seeking were measured by multivariate regression methods.Results:In 2016,the prevalence of fever,cough and dyspnea was respectively 36.23,42.55 and 19.27%.The prevalence of all three symptoms has been declining steadily since 1995,and the percentage of children receiving treatment for fever/cough has also more than doubled during the same time.In multivariable analysis,several sociodemographic factors emerged as significant predictors of ARIs including child’s age and high birth order,mother’s age,educational level,occupation,intendedness status of the child,BMI,household wealth status,and place of residency.Conclusions:The overall prevalence common ARIs(fever,cough,dyspnea)has been declining at a slow but steady rate,however,remains noticeably high in comparison with countries with similar level of per capita GDP in Africa.Findings of this study has important implications for health policy making regarding the prevention of ARIs among infants in the country.

Mass media exposure and its impact on malaria prevention behaviour among adult women in sub-Saharan Africa:results from malaria indicator surveys

Background:Mass media exposure plays a pivotal role in health communication and adoption of a healthy lifestyle.In this study,we aimed to measure the prevalence of malaria prevention behaviour among adult women in eight malariaendemic countries in sub-Saharan Africa(SSA),and assess the influence of mass media exposure in the adoption of those behaviours.Methods:For this study,we collected cross-sectional data on 46,822 women aged between 15 and 49 years from the Malaria Indicator Surveys(MIS)conducted in Burkina Faso,Ghana,Mali,Malawi,Kenya,Nigeria,Sierra Leone and Uganda.As the outcome variable,malaria prevention behaviour was proxied by the use of insecticide treated nets(ITNs)and uptake of antimalarial drugs in last pregnancy.Results:The overall prevalence of sleeping under ITN and that of taking antimalarial drug during the last pregnancy was respectively 67.9%(95%CI=66.6-69.2)and 72.8%(95%CI=71.3-74.2).However,there were disparities in the prevalence of using ITN and antimalarial drug use across the study countries.In the multivariable regression analysis,not receiving malaria related information from radio,poster/billboards,community events,and health workers were found to be significantly associated with reduction in the odds of using ITN the previous night.For the use of antimalarial drugs during last pregnancy,the odds were 23%[OR=0.773,95%CI=0.625-0.956]lower for those who did not receive malaria information on radio compared with those who received.Conclusions:These findings indicate a potentially important role of malaria information received through mass media on utilisation of ITN among women in SSA.More research is needed to explore the factors that limit the accessibility to malaria information through mass media.

The perspective of gender on the Ebola virus using a risk management and population health framework:a scoping review

Background:In the three decades since the first reported case of Ebola virus,most known index cases have been consistently traced to the hunting of“bush meat”,and women have consistently recorded relatively high fatality rates in most catastrophic outbreaks.This paper discusses Ebola-related risk factors,which constantly interact with cultural values,and provides an insight into the link between gender and the risk of contracting infectious diseases,using Ebola virus as an example within Africa.Method:A comprehensive search of the literature was conducted using the PubMed,Ovid Medline and Global Health CABI databases as well as CAB Abstracts,including gray literature.We used a descriptive and sex-and gender-based analysis to revisit previous studies on Ebola outbreaks since 1976 to 2014,and disaggregated the cases and fatality rates according to gender and the sources of known index cases based on available data.Results:In total,approximately 1530 people died in all previous Ebola outbreaks from 1976 to 2012 compared with over 11,310 deaths from the 2014 outbreak.Women’s increased exposure can be attributed to time spent at home and their responsibility for caring for the sick,while men’s increased vulnerability to the virus can be attributed to their responsibility for caring for livestock and to time spent away from home,as most known sources of the index cases have been infected in the process of hunting.We present a conceptual model of a circle of interacting risk factors for Ebola in the African context.Conclusion:There is currently no evidence related to biological differences in female or male sex that increases Ebola virus transmission and vulnerability;rather,there are differences in the level of exposure between men and women.Gender is therefore an important risk factor to consider in the design of health programs.Building the capacity for effective risk communication is a worthwhile investment in public and global health for future emergency responses.

Blood pressure-controlling behavior in relation to educational level and economic status among hypertensive women in Ghana

Objective:To explore the association between economic status and educational level with self-management behavior(medication adherence,controlling body weight,reducing salt intake,performing physical exercise,reducing alcohol consumption,abstaining from smoking,increasing fruit and vegetable consumption)among hypertensive women in Ghana.Methods:Cross-sectional data on 598 women were collected from the Ghana Demographic and Health Survey of 2014.The association between economic status and educational level with self-management behavior was measured by logistic regression methods.Results:Mean systolic blood pressure and diastolic blood pressure were 131.4 and 86.58 mm Hg,respectively.With regard to self-management behavior,81.8%of women reported taking medication to control high blood pressure,44.4%reported controlling body weight,22.5%reported reducing salt intake,48.3%reported performing physical exercise,74.2%reported reducing alcohol consumption,74.2%reported abstaining from alcohol and smoking,and 20.2%reported consuming more fruits and vegetables.Women living in the wealthiest households had significantly higher odds of maintaining healthy weight,reducing salt intake,and exercising.Conclusion:The findings imply that socioeconomic factors may play important roles in women’s adherence to blood pressure-controlling behavior.It is therefore suggested that policy makers focus on improving women’s economic status as a strategy to encourage cardiovascular health-promoting behavior.