Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Role Expectation of Nurse Managers in Geriatric Health Services Facilities

Back ground: The characteristics of geriatric health services facilities (GHSF) in Japan include provision of care focused on the life of the residents, and there is a need for cooperation between care workers and physical therapists responsible for the care. Thus, it is expected that a nurse manager occupies specific roles suited for the above characteristics that are different from those of medical facilities. Thus, we aimed to clarify the role expected of nurse managers via a questionnaire survey administered to nurses and care workers in GHSF. Methods: We used a descriptive, cross-sectional design. The study was conducted in 56 GHSF all over Japan. The instrument used for data collection was a questionnaire. The questionnaires consisted of 35 items for determining role expectation of nurse managers, the background information of respondents. The role of nurse managers was analyzed using principal factor analysis (promax rotation). Findings: A total of 259 nurses and care workers participated in this study. We extracted 34 items by factor analysis, which were classified into three factors (promotion of home nursing, management of medical care, and environment creation for collaboration and education). Among care workers, four factors consisting of 33 items were extracted. Factors one, two, and three were similar to those of nurses;“intervention to ethical problem” was extracted as the additional fourth factor. Conclusion: The roles required for nurse managers in GHSF are the promotion of home nursing, which is the original role of the health services facilities, exhibition of the specialty as a healthcare professional, creation of a work environment that promotes mutual understanding for collaboration with other professionals, and enhancement of the education and training system.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Characteristics of Geriatric Health Service Facilities Designated as Sites of Death

There are many deaths occurring among the aged population in Japan. Geriatric Health Service Facilities (GHSFs) are highlighted as some of the chosen facilities designated as sites of death. The aim of our study was to clarify the characteristics and related factors, including physical signs first noticed by staff at the end-of-life period, in GHSFs designated as sites of death, using a nationwide survey in Japan. We administered a questionnaire to 3971 GHSFs in Japan. Eligible responses for the study were obtained from 854 GHSFs. We found that GHSFs designated as sites of death were more likely to have basic policies and documented preferences regarding end-of-life care. We also found that staff members in GHSFs designated as sites of death were less likely to first notice physical signs of pain. We found that GHSFs designated as sites of death tended to identify earlier symptoms, such as reduced oral intake and less vigor. Our results would enable elderly persons, their families, and staff in GHSFs to prepare for the elderly’s death more efficiently though earlier identification of the end-of-life period. We hope that GHSFs have an important role to play in end-of-life care provision to elderly persons in Japan, through the strengthening of these intermediate facilities.

Participatory approach to design social accountability interventions to improve maternal health services:a case study from the Democratic Republic of the Congo

Background:Social accountability(SA)comprises a set of mechanisms aiming to,on the one hand,enable users to raise their concerns about the health services provided to them(voice),and to hold health providers(HPs)accountable for actions and decisions related to the health service provision.On the other hand,they aim to facilitate HPs to take into account users’needs and expectations in providing care.This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo.Methods:Beneficiaries including men,women,community health workers(CHWs),representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones:(1)Eight focus group discussions(FGDs)were organized separately during consultation aimed at sharing and discussing results from the situation analysis,and collecting suggestions for improvement,(2)Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs,and(3)the integrated suggestions were discussed by research partners and set as intervention components.All the processes were audio-taped,transcribed and analysed using inductive content analysis.Results:Overall there were 121 participants involved in the process,51 were female.They provided 48 suggestions.Their suggestions were integrated into six intervention components during dialogue meetings:(1)use CHWs and a health committee for collecting and transmitting community concerns about health services,(2)build the capacity of the community in terms of knowledge and information,(3)involve community leaders through dialogue meetings,(4)improve the attitude of HPs towards voice and the management of voice at health facility level,(5)involve the health service supervisors in community participation and;(6)use other existing interventions.These components were then articulated into three intervention components during programming to:create a formal voice system,introduce dialogue meetings improving enforceability and answerability,and enhance the health providers’responsiveness.Conclusions:The use of the Dialogue Model,a participatory process,allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components,specific for the two health zones contexts.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

康养旅居产业视域下的康养设施设计

目的:研究康养旅居环境中健康、养生、医疗、旅游等方面存在的潜在需求,解决康养人群的不同需求,例如针对老年人在带小孩的生活中,缺少休憩和锻炼的时间和机会,提出一种适用于这类老年群体的康养互动健身器材和休憩设施的设计方法。方法:针对康养旅居生活中户外运动、休憩、室内服务设施进行研究,构建公共康养设施设计策略,阐述设计实践的过程与内容,运用人机工程学原理进行人群行为分析,指导相关的适老化康养设施和产品设计。结果:通过对上述康养需求的研究,设计出能解决康养人群中的休憩、健身、生活等方面的适老化产品,以改善康养环境的硬件设施,优化康养人群的生活品质。结论:随着中国“老龄化”进程的加速,康养设施匮乏已经成为一个非常严峻的社会问题,以改良和创新相结合的方式,将康养服务理念融入公共设施设计中,促进未来康养产业的发展,从而满足更多人群对康养环境的产品需求,让老年人拥有更幸福的康养时光。

社会医学视角下社区养老卫生服务保障体系的构建与优化研究

基于社会医学视角了解社区养老卫生服务现状,随机对曾在陕西省西安市碑林区社区卫生服务中心就诊的老年人进行问卷调查。结果表明,整体上,社区养老卫生服务质量处于中等偏上水平,医疗设施维度和养老环境维度相对薄弱,是受访老年人认为最需要优化的两个方面。由相关性分析可知,受访老年人的满意度与社区养老卫生服务的便捷性、服务态度、服务公平性、医疗设施情况及养老环境显著相关(P<0.05)。需改善社区养老卫生服务的医疗设施条件,优化服务环境,强化服务的便捷性,提高服务水平,定期对其服务质量进行评估和改进,有效促进医养结合养老服务的发展,才能使社区养老服务体系更加完备和健全,从而更好地满足老年人多样化的养老需求。

河北省社区卫生服务中心中医药服务现状调查

目的调查河北省社区卫生服务中心开展中医药服务的现状,分析存在的问题,为有关部门制定政策提供依据。方法 2013年8月,选取河北省11个地级市的100家社区卫生服务中心及其覆盖的社区居民作为调查对象。采用自制调查表进行调查,内容包括中医药进社区概况、居民对中医药进社区的服务需求等。结果回收有效问卷99份,回收率为99.0%。99家社区卫生服务中心中82家设有中医科,其中75.6%(62家)成立时间是在2008年以后。中医科业务用房面积占总面积的6.2%;中医医师占中心医师总数的18.0%;中医科门诊就诊人次数占总门诊人次数的12.1%;中医医疗收入占总医疗收入的8.2%;中药收入占药品总收入的25.3%。3.8%(31例)的居民患病后首选社区卫生服务中心中医科就诊;居民接受社区卫生服务时首选西医者占54.3%(44例),首选中医者占14.8%(12例),首选中西医结合者占30.9%(25例)。812例居民中218例接受过社区卫生服务,接受率为26.8%(218例),其中满意者占74.3%(162例),不满意者占25.7%(56例)。64.8%(105例)的满意居民认为社区的中医药服务就近方便。结论河北省中医药社区卫生服务在资金投入、中医人力资源方面存在问题和不足,居民对中医药的认识不足,对中医药服务的选择率不高。政府应加大资金投入,制定倾斜政策,加强中医药宣传,鼓励私营性中医药服务与社区卫生服务中心合作。

我国结核病防治服务体系的演变和思考

在过去的近100年中，我国结核病防治服务体系逐步完善，各项防控措施逐步落实，结核病防治工作取得良好成效，但是结核病负担仍然很严重。为快速地减轻我国结核病负担，我国将全面实施新的结核病控制策略。加强结核病定点医疗机构、疾病预防控制机构、基层医疗卫生机构分工明确、协调配合的新型结核病防治服务体系建设是新的结核病控制策略的重要组成部分。随着我国“十三五”规划的开始实施，这一新型服务体系的调整必将进一步加快和完善，并为实现终止结核病流行起到有力的促进作用。

重要会议和大型活动医疗保障工作的实践与思考

近年来,随着我国国际化发展步伐的进一步加快和全球经济一体化进程的不断推进,北京作为全国的政治、文化和国际交往中心,召开具有国际影响力的重要会议日益增多,举办各类大型活动日趋频繁,做好保障重要会议和大型活动的医疗保障工作也显得越来越重要。首都医科大学附属北京友谊医院近3年就平均每年承担医疗保障任务30余项,有着丰富的大量重要会议和大型活动医疗保障经验,本文从组织管理、工作流程和注意事项等多方面进行了经验分享。

养老机构自理和半自理老年人护理服务框架及人员资质研究

目的:构建适合我国的养老机构自理和半自理老年人护理服务内容体系。方法:采用德尔菲法,通过对18名专家的两轮咨询,确定养老机构自理和半自理老年人护理服务框架及服务人员最低资质。结果:两轮咨询问卷的有效回收率分别为75%和100%,专家咨询的权威系数为0.874,判断系数为0.881,熟悉程度为0.867,专家意见协调性好;形成的养老机构护理服务内容体系包括3个服务业态,即独立生活区、辅助生活区和长期护理区;其中独立生活区包括2项一级指标、5项二级指标、18项三级指标,辅助生活区包括2项一级指标、13项二级指标、45项三级指标。结论:养老机构护理服务内容体系经检验,结果真实、科学、可靠,可为养老机构规范护理服务、配置护理人员等奠定基础。

甘肃省结核病实验室资源现况分析

目的了解甘肃省结核病控制体系实验室资源状况,提出改进建议。方法共收集了包括甘肃省省级、14个市(州)级,85个县(区)级结核实验室共计100个实验室信息,统计130名实验员的数量、年龄、教育背景、技术职称、专业构成情况,以及实验室设备和当前的工作,并描述性分析其百分比。结果33.1%(43/130)的实验员教育背景为中专及以下学历;非医学非检验专业人员占13.1%(17/130);兼职人员构成比为19.2%(25/130)。14个地市级实验室不能常规开展药敏试验,76个实验室缺乏生物安全柜,65个实验室缺乏恒温培养箱。结论甘肃省结核病实验室人力资源建设和实验室设备需要加强。

中西部农村地区妇女保健发展的制约因素

在经济落后地区农村妇女保健服务状况堪忧,主要表现在孕产期保健服务质量不高;育龄妇女面临较高的生育风险;生殖系统疾病的困扰。影响这些地区妇女保健发展的因素涉及社会、经济以及妇幼保健服务能力等。通过加强基层医疗服务技术,完善妇幼保健网络,促进健康教育,新型合作医疗的覆盖等不同层次措施的开展,将会改善经济落后地区农村妇女保健的状况。

北京市结核病防治机构护理人员现状分析

通过国家结核病管理信息系统采集2015年北京市18家结核病防治机构（简称“结防机构”）护理人员的数量、年龄、学历、职称、结防护理工作年限等信息，结合北京市2015年肺结核患者登记情况对护理人员人力特征进行比较分析。2015年北京市18家结防机构在编护理人员总数92名，其中6家独立结防机构占63．0％（58／92），隶属疾控中心及综合医院的12家结防机构占37．0%（34／92）；护理人员年龄中位数46岁（P25=36．00，P75=51．00）；大专及以下学历者占83．7％（77／92）；中级职称者占57．6％（53／92），高级职称者占1．1％（1／92）。北京市结防机构护理人员普遍存在年龄偏大，不同类型的结防机构护理人员数量分布不均衡，高级职称护理人员稀缺。结防机构护理人员的年龄、职称、学历构成及人员配置有待进一步优化。

北京市不同成立年限养老机构运行现状差异分析

目的调查北京市不同成立年限养老机构运行现状的差异,为探索适合我国国情的养老机构运营模式提供参考,为相关政策的制定提供理论依据。方法采用便利抽样法,于2014年8月对北京市养老机构进行调查。采用自行设计的问卷进行调查,内容包括机构基本特征、收住情况、员工情况、社会福利功能及医疗保障情况。采用单因素分析及多因素Logistic回归分析不同成立年限养老机构的运行现状。结果共发放问卷374份,回收有效问卷361份,有效回收率为96.5%。361所养老机构中成立年限≤5年57所(15.8%),6~15年161所(44.6%),16~20年31所(8.6%),≥21年112所(31.0%)。不同成立年限养老机构所在区县、机构性质、土地权属、房产权属、总床位数、床位投保率、护理型床位数所占比例、床均占地面积、建筑面积、床均固定资产比较,差异均有统计学意义(P<0.05)。不同成立年限养老机构床位使用率、收住社会人群所占比例、收住60~69岁人群所占比例、收住70~79岁人群所占比例、收住80~89岁人群所占比例、收住≥90岁人群所占比例、收住自理人群所占比例、收住不能自理人群所占比例、收住本乡镇人群所占比例、收住本区县人群所占比例、收住外区县人群所占比例、收住外省人群所占比例比较,差异均有统计学意义(P<0.05)。不同成立年限养老机构的员工总数/床位数、护理员总数/床位数、有无医生、有无护士比较,差异均有统计学意义(P<0.05)。不同成立年限养老机构是否属于低保不能自理人群定点接收机构、收住"三无五保"人群所占比例、有无经卫生部门批准的医疗保障、是否与就近医疗机构签订医疗保障协议、医疗保障是否纳入医保定点比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,不同成立年限养老机构的床位使用率、收住情况、机构性质、医疗保障、人力配置方面比较,差异均有统计学意义(P<0.05)。结论不同成立年限养老机构在床位使用率、收住情况、机构性质、医疗保障、人力配置方面存在差异,应结合不同成立年限养老机构之间的差异,梳理我国机构养老服务的发展趋势,探索适合我国国情的养老机构服务及管理模式。

城市社区卫生服务中心儿童健康服务能力现状研究

背景随着“二孩”政策的开放,我国儿童人口数量逐步增加,儿童健康服务需求呈现快速增长态势,但当前我国社区卫生服务中心儿童健康服务能力尚不清晰。目的了解当前我国部分城市社区卫生服务中心儿童健康服务能力的现状。方法2020年4月,采用多阶段分层抽样的方法,在全国抽取了35家社区卫生服务中心及样本中心的全部儿童相关服务人员作为研究对象。采用自制的样本中心调查表及儿童相关医务人员调查问卷以线上调查的形式,调查社区卫生服务中心的基本情况、人员设备设施配置、业务开展情况及儿童健康服务人员知识水平和满意度等。结果本次调研共包含全国的14个城市的35家社区卫生服务中心,样本中心卫生技术人员总数8009人,儿科医生〔执业范围含儿科学的执业(助理)医师〕191人(2.38%),看儿科的全科医生(通过儿科转岗培训并从事儿科诊疗工作)488人(6.09%),儿保医生320人(4.00%);其中儿科医生154人(80.63%)具有本科及以上学历、112人(58.64%)具有中级及以上职称,看儿科的全科医生293人(65.37%)具有本科及以上学历、355人(79.30%)具有中级及以上职,80.00%以上儿保医生具有执业医师证和培训合格证。共计999人接受满意度和知识水平调查,人员的平均满意度为(61.38±9.11)%,平均知识水平测试正确率(50.40±21.93)%。儿科相关诊疗科室面积平均占比不足1%,超过90%的机构配备了8种儿童常见设备,但仍有超过一半机构的儿童常用的诊疗设备配备不足7种;23种儿童常用药品中仅有10种超过50%的机构进行了配备。2019年度机构平均儿童诊疗人次占2.91%,儿童入院人次占1.48%;国家基本公共卫生项目开展率达85%以上;管理数量最多的重点儿童是单纯性肥胖儿童,最少的是先天性髋关节脱位的儿童。结论社区卫生服务中心儿童相关服务人员数量不足,学历及职称较高但理论知识水平不高,人员满意度较低;社区卫生服务中心儿童医疗相关类设施设备及药品配备不足;儿童健康服务水平空间分布不均衡。为提升社区儿童健康服务能力水平,应加强指导培训以提高基层工作人员的能力水平,建立有效的考核机制以提升基层工作人员的满意度;增加儿童药品种类及数量的配备、合理配置儿童诊疗设备实施。

珠海市香洲区社区卫生服务利用及其影响因素分析

目的了解珠海市香洲区社区卫生服务(CHS)的利用情况和影响因素。方法通过入户调查了解居民的卫生服务需求、对CHS的知晓和利用情况,通过多元Logistic回归筛选CHS利用的影响因素。结果居民对CHS的利用率为46.26%,主要集中于医疗服务,影响居民利用CHS的主要是患病情况、卫生服务机构的设置以及居民对CHS的认同三方面的因素。结论卫生行政部门应当健全对CHS机构的补偿机制,并规范其服务,促进CHS功能的充分发挥。

成都市基层医疗卫生机构服务能力现状研究——基于基本医疗服务提供视角

为了解成都市基层医疗卫生机构服务能力现状,开展了抽样调查。结果显示:成都市基层医疗卫生机构基本医疗服务的提供能力存在较大不足,应加大财政支持与监管力度,加强基层医疗卫生机构临床科室建设,进一步开展常见病诊疗、基本检查以及家庭诊疗项目等服务。