Health Providers’ Points of View on the Impact of the Project to Strengthen the Expanded Program of Routine Vaccination from 2014 to 2018 in the Barumbu Health Zone in Kinshasa, Democratic Republic of Congo

According to the World Health Organization, approximately 3 million deaths are prevented each year in the world thanks to vaccination and then, in addition, each year, it makes it possible to avoid nearly 750,000 children suffering from serious physical, mental or neurological handicaps and 1.5 million other deaths could be avoided if the vaccination coverage is improved. However, vaccination coverage is often not achieved due to various difficulties encountered by health providers in the expanded program on vaccination activities. Yet, it is important to strengthen the program. This research paper aimed to assess health providers’ points of view on the impact of the project to strengthen the routine expanded program on vaccination in the Barumbu health zone in Kinshasa, Democratic Republic of Congo (RDC). To do so, we surveyed a convenience sample of 234 health providers involved in the implementation of the project, including 210 community relays, 9 permanent nurses, 9 health committee chairpersons and 6 health authorities. A questionnaire related to the objective of the research was submitted to them. After analyzing the data, we found that the points of view of health providers are negative. The performance of the vaccination program was not great. Several reasons were given for this, including the non-involvement of the political and administrative authorities, the failure to respect the funds disbursement circuit and the non-effective financing of vaccination activities in the Barumbu health zone in Kinshasa, DRC.

DOST Model’ for DR-TB Patients, New Delhi: Perspectives of Healthcare Providers

Introduction: In India, tuberculosis continues to be a major public health problem and there is a growing concern about drug-resistant tuberculosis as most of the patients are from private sector. The National TB Elimination Programme (NTEP) in collaboration with TB Alert, India (TBAI) and Clinton Health Association of India (CHAI) had implemented a collaborative project to strengthen the network between the private practitioners and public healthcare facilities in New Delhi during 2019 and 2020. Methods: A study was conducted to understand the enablers and challenges encountered by them during the implementation of the project. This is a qualitative exploration of the “healthcare providers” on a project linking DR-TB patients in private sector with government health facilities. The process of data collection involved face-to-face in-depth interviews of healthcare providers, the Doctors mainly from private and public health facilities, the paramedical workers from general health system and paramedical from the project using an interview guide administered through a trained researcher. Results: The study findings revealed that all healthcare providers were completely aware of the DOST project in the health system, the model led to early diagnosis and initiation of quality treatment. There were no major challenges to the implementation of the project. The healthcare providers wish to have this project implemented for a longer duration. Conclusion: The perspectives of healthcare providers towards the “DOST” project were optimistic and call for re-initiating the project in the area.

Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state,Nigeria

Objective:This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria.Materials and Methods:A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study.Participants(104)were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study,respectively.The three-phase delay model directed the study.A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants.Quantitative instrument was tested for reliability,while the qualitative instrument went through the rigors of qualitative data.Results:Findings revealed low level of referral and counter-referral practices as only 19(18.27%)and 30(28.85%),respectively,of care providers referred patients above 10 times in a year.The study also revealed inadequate human and material resources for referrals and counter-referrals.The mean on barriers to referral was 2.90,which was above the cutoff of mean of 2.50,which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies.Conclusions:Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers.Therefore,provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies.There is also a need for teamwork and synergy among all stakeholders in the referral chain.

Influential factors of healthcare provider resilience in disasters:A thematic analysis

Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts.The interviews were conducted face-to-face,and MAXQDA software version 10 was used to organize the data and thematic analysis.Results:The participants included 5 medical emergency technicians,5 physicians,2 Red Crescent technicians,and 8 nurses.The main influential factors of healthcare providers’resilience were limited relief infrastructure,supportive empowerment,organizational capitals,and contradictory consequences.Other important factors were resource limitation,confusion and uncertainty,empowerment training,comprehensive support,human and value capital,social capital,physical capital,suffering,disability,calm,and excellence.Conclusion:Improving healthcare providers’resilience can be achieved by reducing uncertainty,providing the physical,economic,and human resources,strengthening motivation and comprehensive supports.It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters.Moreover,researchers should study each dimension to provide profound knowledge regarding resilience in disasters.

Satisfaction of the Service Provider with the Organization of the Timely Cervical Cancer Detection Program

Cervical cancer is a priority health problem in Mexico. The objective of this work was to know the degree of satisfaction of the service provider with the organization of the program of Timely Detection of Cervical Cancer, specifically in taking of the cervical cytology. The study design was observational, transversal and prospective conducted from January to May 2015 in Jurisdiction 1 of the Health Services of San Luis Potosí, Mexico, in 20 health centers. Participants were 87 service providers whose function is to take cervical cytology (Pap smears). A 32-question questionnaire was applied, with Likert scale with 5 levels of response: 1 (dissatisfied), 2 (little satisfied), 3 (indifferent), 4 (satisfied) and 5 (very satisfied). The score range was 32 points (minimum job satisfaction) up to 160 points (Maximum job satisfaction). We analyzed 2 dimensions: 1) intrinsic factors that have to do with motivation and professional recognition, and 2) extrinsic factors related to infrastructure, materials, remuneration and labor policies. Each factor consisted of four categories. Descriptive statistics and linear correlation of Pearson were applied for the analysis of data. Participants signed an informed consent letter. Of 4 categories, in the intrinsic dimension, the one with the highest percentage of satisfaction was “delegation of activities” with 28.8%. In the extrinsic dimension, the category with the highest percentage of satisfaction was “infrastructure and materials” with 49.4%;while satisfaction increase in intrinsic dimensions also does in extrinsic dimensions, such correlations are significant (p < 0.05), except between delegation of activities and remuneration (r = 0.074 and p = 0.497). The higher hierarchical level, the men, the bachelor academic level and older people showed the highest level of satisfaction.

Views of health service providers on obstacles to tuberculosis control in Ghana

Background:Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis(TB),the disease does present considerable economic and health limitations to individuals infected with,and affected by,the disease,as well as to the health system in general.Despite this fact,insufficient studies have been done on the key barriers to controlling the disease.This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.Methods:In-depth interviews were conducted with frontline health workers involved in TB control in the country.Participants were purposively selected from a pool of national and regional,and district and facility level coordinators of the National Tuberculosis Control Programme(NTP).One key informant was also selected from an international non-governmental organisation(NGO)involved in TB-related activities in Ghana.Observations were utilised to complement the study.Data were analysed inductively.Results:Respondents identified the following as being constraints to TB control:clinical complication,bottlenecks in funding administration,quality of physical infrastructure,competition for attention and funding,unsatisfactory coordination between TB and HIV control programmes,a poor public-private partnership,and weak monitoring and evaluation of interventions.Conclusions:This paper provides evidence of some key barriers to TB control.The barriers,as reported,were generally health system-based.Although this list of barriers is not exhaustive,it would be useful to take them into account when planning for TB control,thus adopting a more rounded approach to TB management in the country.As well as that,further studies should be done to explore patients’views on health service-related barriers to TB control.

Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs

Background Changing health care providers frequently breaks the continuity of care,which is associated with many health care problems.The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C,D and X drugs.Methods A 50% random sample of women who gave a birth in Saskatchewan between January 1,1997 and December 31,2000 were chosen for this study.The association between the number of changes in health care providers and with pregnancy exposure to category C,D,and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression,with adjusted odds ratios （ORs） and its 95% confidence intervals （C/s） as the association measures.Results A total of 18 568 women were included in this study.Rates of FDA C,D,and X drug uses were 14.35%,17.07%,21.72%,and 31.14%,in women with no change of provider,1-2 changes,3-5 changes,and more than 5 changes of health care providers.An association between the number of changes of health care providers and pregnancy exposure to FDA C,D,and X drugs existed in women without chronic diseases but not in women with chronic disease.Conclusion Change of health care providers is associated with pregnancy exposure to FDA category C,D and X drugs in women without chronic diseases.

Closing the Gap: Characterizing Key Factors Leading to the Disparity in Suicide Rates along the Urban-Rural Continuum

Suicide is a top ten cause of mortality in the United States.In previous literature the suicide rates in rural com-munities have been reported to be greater than those of more urban communities.Additionally,these studies have discussed many potential causes for the unfortunate disparity in rates.One cause often discussed is lack of mental health care providers in rural communities.The data for this study was gathered from the CDC’s WONDER data-base and the NPPES NPI Registry.The urban-rural categorization of counties used the 2013 NCHS Urban-Rural Scheme.Statistical analysis included chi-square tests,paired t-tests,and stepwise regression analyses.Results indi-cate that both the number of residents per provider(r=0.35,p≤0.005),and urbanization level(r=0.49,p≤0.001)were significantly related to suicide rate.Additionally,even after controlling for provider rates,each additional level of rurality predicted an increase of 1.2 suicides per 100,000 residents.Ultimately,the number of providers may play a major role in suicide rates,but extra effort must also be made in rural communities to combat the other contextual factors leading to increased suicide rates.

People-Centered Care: Concept Analysis

Purpose: This study aims to clarify the definition, attributes, antecedents, and consequences of the concept of people-centered care (PCC). Method: Rogers and Knafl’s evolutionary method was used to analyze the concept of People-centered care. The cords such as “Attributes,” “Antecedent,” and “Consequences” were extracted on the coding sheet. The extracted contents of each of the “Attributes,” “Antecedent,” and “Consequences” from the created coding sheets were summarized as codes, and similar codes were categorized. Result: We included 33 studies in the analysis. As a result of the analysis, we identified four attributes (the subject is people, approaches to improving and enhancing health issues, relationships as a basis for partnership building, and behavioral attitudes for building partnerships), four antecedents (changes in social conditions, increasing people’s ownership of their health, health issues in modern society, and care in a variety of settings), and three consequences (achieving goals set by the people themselves, self-transformations of both people and healthcare providers, and social transformations). Discussion: Based on the analysis results, PCC was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” In various social and individual changes, the realization of PCC is expected to result in the achievement of goals set by the people themselves together with health care providers and the transformation of individuals and society.

Translation, Cultural Adaption and Validation of Hospital Survey on Patient Safety Culture in Kosovo

Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to target improvements. Creating a culture of safety requires eliminating the culture of blame. In order to formulate actions for improvement, it is important for hospitals to assess their baseline scores for the existing safety culture and to determine the areas of priority. Aim: The aim of this study was first to measure the use, translation in Albanian and adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) assessment as a tool for improving patient safety in Kosovo Hospitals. The second aim was to measure the level of patient safety culture in Kosovo, in seven hospitals and one University Clinical Center (hospitals with over 50 beds, including psychiatric hospitals). Method: The questionnaire (HSOPSC) was translated into Albanian for use in the Kosovo. It was used forward-backward translation: the questions were translated into Albanian by one translator and then translated back into English by an independent translator who was blinded to the original questionnaire. Results: In the eight-factor model, the internal consistency of the factors and the construct validity of the HSOPSC questionnaire were mostly satisfactory. The construct validity was sufficient for all subscales, except for the 4 other subscale regarding intention to report incidents which correlated poorly with other subscales. In total, HSOPSC has 12 dimensions. Cronbach’s α showed that in Kosovarian society, we could use only 8 dimensions model. Conclusion: The hypothesis that HSOPSC would be a suitable instrument to provide important indicators for the improvement of patient safety culture was tested and it was confirmed, that HSOPSC could be used as 8 dimension model. HSOPSC is suitable to improve patient safety culture and provide each hospital with a basic profile on patient safety culture and recommendations for an oriented intervention plan.

Are there differences between the expectations of parents, nurses and physicians when using music in NICU?

This paper aimed to describe and explain the expectations concerning the use of music in NICU from the viewpoints of parents, nurses and physicians. The relevant questionnaires were distributed to 836 participants who were recruited from the country’s five university hospitals (n = 508, response rate 61). Slightly over half of the participants preferred recorded music versus live music in the NICU. They strongly expected that their preferred music could be beneficial both for the infants, parents and staff. The parents agreed most that live music is the most suitable choice for infants (p < 0.001), and that the music could especially benefit the infant (p < 0.001) and parents (p < 0.001) compared with the nurses’ and physicians’ preferences. Some background details such as age, average length of time listening to music, musical training and experiences of using music provided significant explanations for the participants’ expectations. In conclusion, there were significant differences between the groups of the respondents concerning the type of the preferred music and its expected effects. This highlights the importance of discussion with the caregivers when taking music into regular use in the neonatal intensive care units.

Implementing uterine balloon tamponade(UBT)device for immediate postpartum hemorrhage management:Leveraging resource allocation and highlighting noteworthy experiences

Background The use of uterine balloon tamponade(UBT)devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal mortality.Objective This report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'Ivoire.Material and methods A four-year retrospective study was conducted in the North-East(163,645),North-Center(351,909),and North-West(57,983).In 2017,UBT was adopted by members of the healthcare system.Subsequently,5 national and 32 regional trainers have been trained.The training session was a theoretical and practical program with a low simulator.UBT is a male condom tied to a urinary catheter,filled with liquid.Positive outcomes included stopping bleeding,avoiding the need for surgery,and preventing maternal deaths(MD).In 2018,3,515 UBT devices were distributed.In 2019,monitoring tools and transmission circuits of the data were validated.In 2020,the collection of data and local manufacturing was launched.Results During the process,978 health workers,mainly midwife(52.0%)and nurses(32.2%)out of the 1,295 assigned were trained.The number of trained individuals decreased from 209 in 2019 to 160 in 2020.A total of 1,715 UBT devices were locally manufactured,adding to the existing gift of 5,080 devices,with total availability of 6,795.The distribution of devices increased from 2017 to 2019 but decreased in 2020.Success rates increased from 87.3%in 2017(365/418)to 95.0%in 2019(556/585)and slightly decreased in 2020 to 98.0%(681/695).Adverse outcomes(144/2,193),included MD(35/2,193)and medical evacuation to the surgical center(109/2,193).Conclusion The implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage(IPPH).However,to ensure sustainability,further improvements are needed,including increased monitoring,ongoing training,and device availability.

Sexual counseling and cardiovascular disease： practical approaches

Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.