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.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis （TB）. The TB prevention and treatment staff in health care facilities are responsible for the identification, diagnosis, treatment, supervision, and management of TB patients .

Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Assessment of Active Case Search of COVID-19 in Healthcare Facilities during the Third Wave of the Pandemic in Ekiti State, Nigeria

Early case detection and isolation of patients infected with highly infectious diseases through active case search (ACS) are important for early commencement of treatment and control of the disease within a population. This study aimed to assess the ACS of COVID-19 in healthcare facilities during the third wave of the pandemic in Ekiti State, Nigeria. This cross-sectional study was conducted in all healthcare facilities in Ekiti State. All cadres of local government primary healthcare workers were trained to carry out the ACS using semi-structured interviewer-administered questionnaire uploaded on android phone software open data kit (ODK). ACS was conducted between June and September (epidemiological week 23 to 36), 2021 and the collected data were analyzed using IBM SPSS version 23.0. P-value < 0.05 was taken as significant. The number of ACS visits for COVID-19 increases with epidemiological week progression, but the highest was in week 32 (9.9%). Cases of suspected COVID-19 in the healthcare facilities in the last one week were reported in more than half (58%) of the visits and 57.8% of those reported, documented between 1 - 4 cases. Also, out of those that were reported, 42% of them missed (not line listed) at least one suspected case of COVID-19. The private health facilities missed more cases of COVID-19 (54.3%) than other categories of health facilities (p < 0.001). The health educators and local government immunization officers (LIO) than other cadre of healthcare workers found most missed cases (57.1% and 51.4% respectively) in their visits (p < 0.001). The health educator as well as the LIO detected the highest proportion of missed suspected cases which shows that disease surveillance officers alone may not be adequate for ACS, there is a need to involve other local government team member.

Patients’ Preferences of Healthcare Facilities for Quality Healthcare Services in Akwa Ibom State: A Game Theory Approach

The purpose of this work is to apply Game theory approach to determine patients’ preferences of healthcare facilities for quality healthcare in Akwa Ibom State. Cross-sectional descriptive study and purposive sampling technique were adopted in order to collect the relevant data. Factors influencing patients’ preferences of health care facilities between public and private hospitals in Akwa Ibom State were assessed using a set of questionnaires which were distributed to 9976 patients in University of Uyo Teaching Hospital, Uyo, Akwa Ibom State. A two-person zero sum game theory approach was applied. Perception of quality healthcare services received by respondent’s preferred facilities between public and private hospitals was examined. Also the reasons for patients’ persistence of their preferred facilities were evaluated using questionnaire. The optimal strategy and the value of the game were determined using the factors influencing patients’ preferences of healthcare facilities, and analysed with two-person-zero-sum game. Facility that gives their clients the best satisfaction was identified. The data collected through questionnaire were analysed using the rules of dominance in a two-person-zero-sum game and TORA statistical software was employed. The result shows that the value of the game, v = 330 which implies that the game is favourable to public hospital. The result also showed that patients preferred public hospitals due to costs of services with probability one (1), while private hospitals attributed their preferences to attitude of healthcare providers with probability one (1).

The Epidemiological Profil of Digestive Cancers in Secondary and Tertiary Health Care Facilities in Cameroon

Background: Cancers have been a major public health problem in developing countries in recent years. The aim of this study was to determine the epidemiological profile of digestive cancers in secondary and tertiary health care facilities in Cameroon. Methodology: This was a cross sectional and descriptive study conducted over a period of 12 months in 14 health structures over the national territory. Included in our study were patients aged 15 and above with a histologically proven digestive cancer, patients with a clinical, biological and morphologic evidence of a digestive cancer. Socio-demographic (age, gender, region of origin, profession), clinical (symptoms on diagnosis, personal and family past history, consumption habits, tumour location) and paraclinical data were recorded on a pretested questionnaire. Data was analysed using SPSS version 20.0. Quantitative data was expressed as means with their corresponding standard deviations. Chi square was used for correlation between variables. A P value 0.05 was considered statistically significant. Results: Five hundred and eighty-two cases of digestive cancers were recorded out of 37,780 consultations/admissions during the study period giving a prevalence of 1.5% with a male predominance (58.1%). The mean age was 53.11 ± 17.26 years (15 - 99) with 33.8% of them below 45 years of age. Tumours were predominantly localized in the liver (43.5%) and colon (24.9%). Adenocarcinoma was the most common histological type in 44.5% of all cases. Alcohol consumption was found to be associated with colorectal cancer (p = 0.028) while tobacco consumption was found to be significantly associated with oesophageal cancer (p ≤ 0.001) and gastric cancer (p = 0.0047). Conclusion: A third of patients with digestive cancers were aged less than 45 years suggesting an early onset of these cancers in our setting. Relatively low prevalence with the liver being the most common site of localisation in our setting.

Method to Evaluate the Location of Aged Care Facilitiesin Urban Areas Focusing on the Equity in Terms ofUsers’Accessibility

The present study developed and tested a method to evaluate the location of aged care facilities from the viewpoint of whether they are equitably located for users,using the improved Median Share Ratio(MSR).By evaluating the current location of aged care facilities,it is possible to extract the districts which are short of facilities.The evaluation method was applied to Chofu and Kiyose Cities in Tokyo Metropolis,Japan,and the evaluation result of weighting and that of not weighting by elderly population were compared and discussed.Consequently,adopting the evaluation method with weighting by elderly population,it is possible to adequately examine the districts where new aged care facilities should be constructed.From this evidence,it is significant to evaluate the location of aged care facilities,using the improved MSR with weighting by elderly population in the study.

Modelling geographic accessibility to Primary Health Care Facilities:combining open data and geospatial analysis

Ensuring healthy lives and promoting well-being for all ages is the 3rd Sustainable Development Goal(SDG).Inequality in access to health care remains one of the primary challenges in achieving the goal.With the ever-increasing expansion of urban areas and population growth,there is a need to regularly examine the pattern of accessibility of basic amenities across regions,States and urban areas.This study examined geographic access to Primary Health Care Facilities(PHCF)in Nigeria using the combination of open data and geospatial analysis techniques.Thus,showcasing an approach can be replicated across different regions in Sub-Saharan Africa due to issues of information gap.Data on elevation,location of health care facilities,population and network data were utilised.The result shows that PHCF aggregate at certain locations,e.g.major urban agglomerations,and transit route leading to these places.High concentrations are found in the capital city.The average travel time to the nearest PHCF is about 14 min(Standard Deviation±13.30 min)while the maximum is about 2 hours.Pockets of low accessibility areas exist across the Akwa Ibom State in the Niger Delta region of Nigeria.There is an indication that most places have good geographic access.Across the 1787 settlements identified in our dataset,98.3%are with good access(<30 min),27 settlements are located in the poor access class(31–60 min),while two settlements are within the very poor access class(>60 min).Geographic access is not the main limiting factor to health care access in the region.Therefore,computation of access to health care should take into consideration other dimensions of accessibility,to create a robust measure which will support effective and efficient health care planning and delivery.

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.

Contemporary Designs for Long-Term Care (LTC) Facilities

In addition to experiencing shortage in LTC workforce, some existing facilities are unable to provide quality service, since they were designed and built decades ago. Thus, the renovation of outdated LTC facilities is currently an unavoidable issue. In this paper, some contemporary practices are presented related to renovating old LTC facilities to improve the quality of service. The most important concept is the person-centered design. Some other elements include the importance of natural lighting for residents, proper practices of flooring and picking doors, some details in home-like design, new guidelines for resident rooms’ design, and other miscellaneous issues. Furthermore, the latest Americans with Disabilities Act (ADA) compliance protocols are reviewed, and some crucial elements are discussed to ensure the renovations will make the facilities compliant with the current standards.

Measuring the spatial and social characteristics of the architectural plans of aged care facilities

This paper presents a method that combines visibility graph and isovist analyses to investigate the spatia[ and social properties of architectural plans for aged care facilities. The potential of the combined method is examined by measuring the properties of three sets of plans for residential aged care facilities. The first set is a pair of hypothetical, idealized plans, which allegedly reflect the ＂best practice＂ in the industry. The second set comprises a pair of plans for recent Australian designs, and the third set is a pair of plans for South Korean facilities. Results of the computational anatysis of these six plans suggest that social and cultural factors may shape the design of aged care settings and partially explain their international differences. The application of this methodological approach contributes to the understanding of the relation- ship between spaces and their cultural and social properties in the design of aged care facitities.

Evaluation of Care Quality Related to Dietary Intake and Swallowing Functions of Residents at Long-Term Facilities in Japan

This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care facilities. We investigated outcome indicators, such as changes in dietary intake and swallowing function levels of residents, and clarified which structural and process indicators were associated with the outcome indicators. This was a retrospective study, analyzing information on healthcare services from 1067 long-term care facilities during the fiscal year 2012, sampled from among those registered with the Welfare, Health and Medical Care Information Network of the Welfare and Medical Service Agency in Japan. Five outcome indicators were identified. Next, we examined the relationships between the outcome indicators and structural or process indicators using a multivariate linear regression model, adjusting for facility type. The findings showed how the five outcome indicators were used in long-term care facilities over a period of one year and determined the independent predictors of these outcome indicators. The amplification of dietary function 1 was associated with “assessment of oral functions using a feeding and swallowing assessment checklist every three months”, “holding care conferences related to ingestion and swallowing every three months”, and “maintaining a 1:2 ratio for meal-time assistants to residents”. To improve the quality of care, it is necessary to increase the number of staff (e.g., to provide meal assistance to residents) and to understand changes in the residents’ status through accurate assessment and monitoring.

Person-centered Care for Institutionalized Older Adults in the Context of the COVID-19 Pandemic in Brazil

Objective:This study aims to discuss the caregiving practices developed by Long-term Care Facilities(LTCFs)during the COVID-19 pandemic and analyze the daily care practices in long-term institutions for older adults in Brazil,all in light of the PCC framework.Methods:This is a mixed methods study in which data were collected through interviews with managers from 10 LTCFs.The qualitative discussion was carried out through the PCC framework divided into 5 categories:leisure,accommodation,food,hygiene and comfort,and clinical care.The quantitative data collected were analyzed in a descriptive way,being discussed in the light of the literature.Results:Analyzed LTCFs are unaware of our present difficulties in the implementation of PCC,with a greater presence of the traditional biomedical model being recognized.Given the vulnerabilities that the LTCFs present,PCC is an important alternative for LTCFs to promote the quality of life and autonomy of residents.Deconstructing the vision of LTCFs as a last resort of care and investing in the quality of care is an urgent and essential imperative for dignified and comprehensive care.Conclusions:This study highlights the need for a change in culture and understanding of the LTCFs not only as a place to provide healthcare,but also as a residents’home that fosters their autonomy,and feeling of belonging.Thus,it is essential to ensure that healthcare teams in LTCFs know about PCC and that further studies investigate the impact on the costs of PCC for institutionalized older adults.

Spatial Differentiation and Influencing Mechanism of Medical Care Accessibility in Beijing:A Migrant Equality Perspective

Spatial equality of access to basic public services, especially medical care services which are directly related to life safety, is the first step to achieve the goal of equalization of basic public services for all the people proposed by central government of China. Using the spatial analysis and the statistical analysis, this study evaluates the spatial differentiation of medical care facilities accessibility by constructing STT(Shortest Travel-Time) and SAI(Spatial Accessibility Index). And then this study explores the neighborhood effects on the medical care facilities accessibility in Beijing, with a particular focus on the effect of neighborhood migrant proportion by constructing spatial dependent regression model. The spatial accessibility analysis of medical care facilities show that the spatial distribution of medical care facilities was basically consistent with administrative regions but not with population demands. Bivariate LISA cluster maps identify that suburban areas are the overlapped clusters of high percent of migrants and limited medical care services. This is associated with the public service allocation rule in China, which stresses equality within urban areas and within rural areas but overlooks equality between urban areas and rural areas; and stresses local resident demands but overlooks migrant demands. To estimate the effects on medical care accessibility of neighborhood migrant proportion, spatial dependence models are applied due to spatial dependence of accessibility of medical care facilities. The regression results show that neighborhoods with high percent of migrants, even conditioning on neighborhood SES, are related to limited spatial accessibility of medical care services. Besides neighborhood characteristics, another important factor influencing spatial accessibility of medical care services is the process of spatial spillover effects. This indicates that the attenuate accessibility of medical care services for migrants is not only because of their own constraints but also because of their proximity to other disadvantaged neighborhoods. Therefore, it is urgently needed to increase the medical facilities in the suburban areas, to take into account migrants' demands and to reduce residential segregation between local residents and migrants for local governments to achieve the goal of equalization of medical care service.

The Rhythm of the Unit Is the Pace of Life:A Study of Everyday Activities and Sleep in Swedish Residential Care

Social and physical activities can improve sleep in older people. However, living in a residential care facility has been associated with a limited potential for activities and increased inactivity, reflected in poor sleep among residents. In turn, poor sleep can impair physical and mental functions. This paper explores sleep habits and everyday activities at three residential care facilities and investigates the link between sleep habits and everyday activities from the perspective of the residents. Data were collected through observations of daily life and interviews with residents. The results showed that fixed times during the day reduced daytime sleep and motivated them to go to the day room, thus enabling social interaction. More impaired residents spent more time in the day room napping or being less active. The residents stated that going outdoors was a desired activity, thought to improve sleep. However, the activity did not occur to the extent the residents wished for. Maintaining mobility and influence over daily activities together with regularity seemed to improve sleep. Awareness among staff of the need for stimulating and enriching activities, as well as access to bright light is requisite. Specific consideration should be given to residents who have difficulties communicating their wishes and/or impaired mobility.

Choice of place for childbirth among pregnant women accessing antenatal care at Nnamdi Azikiwe University Teaching Hospital,Nnewi,Nigeria:a descriptive study

Objective:This study determined choice of place of delivery among women accessing antenatal care clinic s in Nnamdi Azikiwe University Teaching Hospital(NAUTH)Nnewi in Anambra state.Methods:A descriptive survey was conducted with three hundred and twenty-two pregnant women who registered for antenatal care at Nnamdi Azikiwe University Teaching Hospital,Nn ewi.Data were collected using a self-structured questionnaire and analyzed with a Chi-square test of association and Fisher’s exact test were used to test the hypothesis at 5%level of significance.Results:Findings from the study showed that 39.75%of the pregnant women chose private hospital s as their place of delivery,37.27%chose NAUTH,6.52%and 7.14%chose other government hospitals and home delivery,respectively.There was a significant difference between education level and occupation of the participants in the choice of place of childbirth.Privacy,finance,distance and approach of health workers were significant predictors of choice of delivery place among the women.Conclusion:Health planners need to recognize the determinant choice of delivery place as more efforts should be given to educate women and empower them.However,utilization of tertiary health facilities for childbirth m ay increase if the privacy of pregnant women is maintained,health workers relate well with clients and the cost of health care services is reduced.

COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes

Background:COVID-19 outbreaks in residential care homes for the elderly(RCHEs)and for persons with disability(RCHDs)have caused significant morbidity and mortality during 5th epidemic in Hong Kong.This article reviewed COVID-19 outbreaks situation and estimated the effectiveness of receiving at least two-dose of COVID-19 vaccine in preventing severe outcomes.Methods:To estimate attack rates and vaccination coverage,documentation on COVID-19 infection and their vaccination records of residential care homes(RCH)residents reported between December 31,2021 and May 31,2022 were reviewed,and infected cases were follow-up for 4 weeks for severe outcomes or death.Correlation between vaccination coverage against attack rate by types of homes was examined.Infected RCH residents with available information were included in the analysis of vaccine effectiveness against severe outcomes and death.Results:COVID-19 vaccination coverage was low in RCHDs(median 0.46,IQR:0.24-0.76)and very low in RCHEs(median 0.08,IQR:0.00-0.19).Higher attack rates were recorded among RCHE residents(median 0.84,IQR:0.64-0.93)and higher case fatality rate(CFR:28.1%)than in RCHDs(median 0.58,IQR:0.31-0.84;CFR:3.9%).The attack rate decreased when vaccination coverage increased for both RCHEs(ρ=−0.131,p<0.001)and RCHDs(ρ=−0.333,p<0.001).Comparing with infected residents who were unvaccinated/vaccinated with one-dose,receiving at least two-dose was estimated to be effective in reducing severe outcomes in 31%and 36%of infected RCHE and RCHD residents respectively;with greater reduction in mortality among RCHD than RCHE residents(54%and 38%,respectively).Vaccine effectiveness of two-dose of BNT162b2 against severe outcomes and death are higher than that of CoronaVac.Conclusions:Increasing COVID-19 vaccination could have significant impact on reducing the risk of COVID-19 outbreaks in RCHs.At least two-dose of COVID-19 vaccine is still effective in reducing severe outcomes and death among infected residents in RCHs during Omicron epidemic.

Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios

While surveillance can identify changes in COVID-19 transmission patterns over time and space,sections of the population at risk,and the efficacy of public health measures,reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases.Our primary objective was to estimate the percentage of cases reported in the general community,considered as those that occurred outside of long-term care facilities(LTCFs),in specific provinces and Canada as a whole.We applied a methodology using the delay-adjusted case fatality ratio(CFR)to all cases and deaths,as well as those representing the general community.Our second objective was to assess whether the assumed CFR(mean=1.38%)was appropriate for calculating underestimation of cases in Canada.Estimates were developed for the period from March 11th,2020 to September 16th,2020.Estimates of the percentage of cases reported(PrCR)and CFR varied spatially and temporally across Canada.For the majority of provinces,and for Canada as a whole,the PrCR increased through the early stages of the pandemic.The estimated PrCR in general community settings for all of Canada increased from 18.1%to 69.0%throughout the entire study period.Estimates were greater when considering only those data from outside of LTCFs.The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07%on March 11th,2020 to 2.00%on September 16th,2020.Therefore,the true CFR in the general community in Canada was likely less than 2%on September 16th.According to our analysis,some provinces,such as Alberta,Manitoba,Newfoundland and Labrador,Nova Scotia,and Saskatchewan reported a greater percentage of cases as of September 16th,compared to British Columbia,Ontario,and Quebec.This could be due to differences in testing rates and criteria,demographics,socioeconomic factors,race,and access to healthcare among the provinces.Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study.The estimates provide context to the summative state of the pandemic in Canada,and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.