Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance,effectiveness,and safety of healthcare services.These indicators provide a systematic way to evaluate the quality of care offered,and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices.Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives.Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care.By systematically tracking and analyzing indicators related to infection control,treatment effectiveness,and adherence to protocols,respiratory care practitioners can identify areas to improve and implement evidence-based changes.This article reviewed how to identify,implement,and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Influence of the continuing COVID-19 epidemic on sleep quality and psychological status of healthcare workers in private institutions

BACKGROUND On January 22,2020,Macao reported its first case of coronavirus disease 2019(COVID-19)infection.By August 2021,the situation had escalated into a crisis of community transmission.In response,the government launched a recruitment campaign seeking assistance and services of healthcare workers(HCWs)from the private sector throughout Macao.These participants faced concerns about their own health and that of their families,as well as the responsibility of maintaining public health and wellness.This study aims to determine whether the ongoing epidemic has caused them physical and psychological distress.AIM To examine the influence of COVID-19 on the sleep quality and psychological status of HCWs in private institutions in Macao during the pandemic.METHODS Data were collected from December 2020 to January 2022.Two consecutive surveys were conducted.The Pittsburgh Sleep Quality Index(PSQI)scale,Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were employed as investigation tools.RESULTS In the first-stage survey,32%of HCWs experienced a sleep disorder,compared to 28.45%in the second-stage survey.A total of 31.25%of HCWs in the first-stage survey and 28.03%in the second had varying degrees of anxiety.A total of 50.00%of HCWs in the first-stage survey and 50.63%in the second experienced varying degrees of depression.No difference in PSQI scores,SAS scores,or SDS scores were observed between the two surveys,indicating that the COVID-19 epidemic influenced the sleep quality and psychological status of HCWs.The negative influence persisted over both periods but did not increase remarkably for more than a year.However,a positive correlation was observed between the PSQI,SAS,and SDS scores(r=0.428-0.775,P<0.01),indicating that when one of these states deteriorated,the other two tended to deteriorate as well.CONCLUSION The sleep quality,anxiety,and depression of HCWs in private institution in Macao were affected by the COVID-19 epidemic.While these factors did not deteriorate significantly,the negative effects persisted for a year and remained noteworthy.

Quality indicators for the care of older adults with disabilities in longterm care facilities based on Maslow’s hierarchy of needs

Purpose:This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities(LTCFs)based on Maslow’s hierarchy of needs.Methods:The draft of the quality indicators was drawn up based on a literature review and research group discussion.The quality indicators were finalized by two rounds of expert consultation(involving 15 experts)using the Delphi method.The Analytic Hierarchy Process was applied to calculate the indicators’weight.Results:The response rates of the two rounds of consultation were 100%and 93%,and the expert authority coefficients were 0.86 and 0.87.After two rounds of consultation,the expert opinion coordination coefficients of the first-,second-and third-level indicators were 0.42,0.25,and 0.96,respectively(P<0.05),and the variation coefficient was0.25.The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level,19 second-level,and 107 third-level indicators.Conclusion:The quality indicators for the care of older adults with disabilities in LTCFs are reliable,scientific,comprehensive,and practical and specify the content of person-centered care needs.This can provide a reference for evaluating and improving care quality in LTCFs.

Quality 4.0 technologies to enhance traditional Chinese medicine for overcoming healthcare challenges during COVID-19

The Quality 4.0 concept is derived from the industrial fourth revolution,i.e.,Industry 4.0.Quality 4.0 is the future of quality,where new digital and disruptive technologies are used to maintain quality in organizations.It is also suitable for traditional Chinese medicine(TCM)to maintain quality.This quality revolution aims to improve industrial and service sectors’quality by incorporating emerging technologies to connect physical systems with the natural world.The proposed digital philosophy can update and enhance the entire TCM treatment methodology to become more effective and attractive in the current competitive structure of the pharmaceutical and clinical industries.Thus,in healthcare,this revolution empowers quality treatment during the COVID-19 pandemic.There is a major requirement in healthcare to maintain the quality of medical tools,equipment,and treatment processes during a pandemic.Digital technologies can widely be used to provide innovative products and services with excellent quality for TCM.In this paper,we discuss the significant role of Quality 4.0 and how it can be used to maintain healthcare quality and fulfill challenges during the pandemic.Additionally,we discuss 10 significant applications of Quality 4.0 in healthcare during the COVID-19 pandemic.These technologies will provide unique benefits to maintain the quality of TCM throughout the treatment process.With Quality 4.0,quality can be maintained using innovative and advanced digital technologies.

Quality indicators for colonoscopy: Current insights and caveats

Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them,as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequatebowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.

Quality indicators in pediatric colonoscopy in a low-volume center:Implications for training

AIM To study implications of measuring quality indicators on training and trainees' performance in pediatric colonoscopy in a low-volume training center.METHODS We reviewed retrospectively the performance of pediatric colonoscopies in a training center in Malaysia over 5 years(January 2010-December 2015), benchmarked against five quality indicators: appropriateness of indications, bowel preparations, cecum and ileal examination rates, and complications. The European Society of Gastrointestinal Endoscopy guideline for pediatric endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition training guidelines were used as benchmarks.RESULTS Median(± SD) age of 121 children [males = 74(61.2%)] who had 177 colonoscopies was 7.0(± 4.6) years. On average, 30 colonoscopies were performed each year(range: 19-58). Except for investigations of abdominal pain(21/177, 17%), indications for colonoscopies were appropriate in the remaining 83%. Bowel preparation was good in 87%. One patient(0.6%) with severe Crohn's disease had bowel perforation. Cecum examination and ileal intubation rate was 95% and 68.1%. Ileal intubation rate was significantly higher in diagnosing or assessing inflammatory bowel disease(IBD) than non-IBD(72.9% vs 50.0%; P = 0.016). Performance of four trainees was consistent throughout the study period. Average cecum and ileal examination rate among trainees were 97% and 77%.CONCLUSION Benchmarking against established guidelines helps units with a low-volume of colonoscopies to identify area for further improvement.

Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

BACKGROUND Inflammatory bowel diseases(IBD)have been associated with a low quality of life(QoL)and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease(CD)or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin>200μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria)and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(α=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6%female,38.3%/37.1%employed),44.7%/25.2%presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P<0.05).Median work productivity impairment was 20%and 5%for CD and UC patients,respectively,and activity impairment was 30%,the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity(75.0%vs 10.0%,P<0.001).For CD/UC patients,respectively,25.4%/2.8%had at least one surgery,38.3%/19.6%were hospitalized,and 70.7%/77.6%changed IBD treatment at least once during the last 3 years.The most common treatments at baseline were biologics(75.3%)and immunosuppressants(70.9%)for CD patients and 5-ASA compounds(77.5%)for UC patients.CONCLUSION Moderate to severe IBD activity,especially among CD patients,is associated with a substantial impact on QoL,work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.

Studying Design and Use of Healthcare Technologies in Interaction: The Social Learning Perspective in a Dutch Quality Improvement Collaborative Program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effects.

The Impact of Lean Six Sigma Practices on Physiotherapy Services Quality at UNRWA Healthcare Centers, Gaza Strip, Palestine

Integrating Lean and Six Sigma found a powerful business tool for the strategy improvement process and saving time is produced. The main aim of this study is to identify the impact of Lean Six Sigma (LSS) practices on physiotherapy service quality at healthcare centers of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), using a descriptive-analytical approach. Data were collected using a questionnaire distributed among 49 physiotherapists working at UNRWA healthcare centers as a census sampling method between July 2016 and August 2017, following the stratified random sampling method. The Statistical Package for Social Science (SPSS) was used to analyze the collected data. The results revealed that there was a statistically significant relationship between Lean Six Sigma (LSS) dimensions and the quality of healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Moreover, the application of Lean Six Sigma dimensions was adopted at 81% of UNRWA healthcare centers. Moreover, the percentage of patients’ satisfaction regarding the quality of healthcare services provided in physiotherapy units was 89%. The study emphasized the effectiveness of Lean Six Sigma dimensions application on the quality healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Furthermore, employee training and reward according to a needs assessment to implement Lean Six Sigma successfully is highly recommended.

Evaluation of Health-Related Quality of Life Associated with Provision of Healthcare to Stroke Patients Living at Home in Japan

Objective: As stroke mortality rates decline in Japan, a large proportion of disabled stroke survivors living in their homes are supported by informal caregivers or formal healthcare services. To evaluate the impact of healthcare provision on outcome of stroke patients living at home, this study investigated the associations of long-term care and health-related quality of life (HRQOL) in patients 1 year after stroke onset. Methods: Data on patient and caregiver characteristics, HRQOL of patients, and healthcare services for those living at home were prospectively collected from 426 patients with stroke at baseline and 12 months. Using general measures of HRQOL, namely, Short Form-36 (SF-36) and EuroQOL 5 dimension (EQ-5D), multivariate regression models were used to determine the contribution of variables to changes in HRQOL scores from discharge to the first year after stroke. Results: Five domains of SF-36—role-physical, vitality, social functioning, role- emotional, and mental health—were significantly improved 1 year after stroke. Factors affecting changes in the five domains of HRQOL were age, independence in activities of daily living, and cognitive function. Home care service was positively associated with role-physical, social functioning, and role-emotional. In addition, home rehabilitation and home bathing services were positively associated with social functioning. Conclusion: This study clarified that improvements of HRQOL 1 year after stroke were associated with use of home-based services involving home care service, home rehabilitation, and home bathing services. The use of home-based services contributed to the improved welfare of patients living at home.

Evaluation of Laboratory Performance with Quality Indicators in Infectious Disease Hospital, Kano, Nigeria

Background: In January 2010, the implementation of quality management systems toward WHO-AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the Infectious Disease Hospital, Kano, Nigeria. Quality improvement projects were instituted in 2011 in line with ISO 15189 requirements for accreditation of medical laboratory. In this study we evaluated the performance of the laboratory through some set of quality indicators (QI). Methodology: This was a retrospective study to evaluate laboratory QIs monitored from January 2011 to December 2013. The QIs were specimen rejection rate (SSR), turnaround time (TAT), proficiency testing performance (PTP) and client satisfaction survey (CSS). Data was collected into an excel file for analysis and percentage performance compared among years. SSR & TAT were evaluated with the Sigma scale. Results: A total of 7920 (2194 in 2011, 2715 in 2012, 3011 in 2013) specimens were received for testing. 22 (0.28%) specimens were rejected and 81 (1.02%) specimens’ results were reported after the acceptable TAT, giving a Sigma level of 4.27 and 3.82 for SSR and TAT respectively. There was steady improvement in PTP: CD4+ from 67% in 2011 to 90% in 2013, hematology from 81% in 2012 to 83% in 2013, blood film reading 79% in 2011 to 83% in 2013 and chemistry from 90% in 2011 to 93% in 2013. HIV serology recorded 100% throughout. CSS increased from 59% in 2012 to 78% in 2013. However, there was no statistically significance difference reported for PTP and CSS over the years (P > 0.05). Conclusion: The study highlights the need to continuously evaluate QIs and calls for more effort to improve on PTP and focuses on understanding and improving on clients concerns.

Canonical Correlation between the Leaf Quality Indicators of "Moderate Aroma" Flue-cured Tobacco

In order to find out the correlation between tobacco quality evaluation indicators in China's traditional " moderate aroma" tobaccoproducing areas and simplify the tobacco quality evaluation indicators,we evaluate the appearance quality and smoking quality of 143 flue-cured tobacco leaf samples in China's " moderate aroma" tobacco-producing areas,test the physical traits and chemical component,and analyze the canonical correlation between four quality evaluation indicators. The results show that there is significant or extremely significant canonical correlation between four evaluation indicators( tobacco smoking quality,chemical component,appearance quality and physical trait quality); the cumulative variance contribution rate of evaluation indicators is in the order of chemical component( 69. 17%) > appearance quality( 68. 76%) > physical traits( 64. 13%); appearance quality is most closely related to physical traits( 93. 84%). The individual indicators for tobacco quality evaluation make different contribution to the correlation between quality evaluation indicators. The chemical component evaluation indicators mainly include total sugar and ratio of total sugar to betaine; sensory taste indicators mainly include aroma volume,smoke concentration,irritation and softness degree; physical trait evaluation indicators mainly include leaf weight,leaf length and leaf density; appearance quality indicators mainly include leaf organizational structure,color,maturity and identity. Studies have shown that in the large-scale ecoregion,using canonical correlation analysis to simplify tobacco quality evaluation indicators is feasible.

The Effect of Public Healthcare Service Quality on Residents’ Satisfaction in the United Arab Emirates (UAE), the Case of Ajman Emirate

The quality of healthcare services is becoming a major concern in all countries, through improving performance to maximize the population health, effectively and efficiently, by doing the right thing, at the right time, in the right way, for the right person and having the best possible results, through well-managed hospitals and clinics. The purpose of this paper is to identify and measure Ajman residents’ satisfaction on healthcare service, using data of a sample of 1035 households, randomly selected from a total of 95,531 households, who were permanently residing in the Emirate of Ajman and having prior experience in availing any healthcare service. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22 and AMOS version 22. Structural Equation Modeling (SEM) analysis showed an acceptable model fit used to measure residents’ satisfaction. Findings showed that in the government sector only reliability and empathy correlated positively with healthcare service quality, which also had a strong, positive correlation with residents’ satisfaction, while tangible, assurance and responsiveness were not sufficiently correlated to healthcare service quality. On the other hand, for private sector, except for responsiveness and tangible dimensions, reliability, assurance, and empathy correlated positively with healthcare service quality, which also had a strong, positive correlation with residents’ satisfaction. This study used healthcare service quality dimensions, namely, tangible, reliability, responsiveness, assurance, and empathy, to determine the residents’ satisfaction within the public hospitals and to provide an empirical contribution to understanding the factors associated with public satisfaction and healthcare systems. According to the survey results, Ajman residents were satisfied 82% on Quality Dimension, 77% on Empathy Dimension, 80% on both Assurance and responsiveness Dimensions, 89% on Reliability Dimension and 88% on Tangible Dimension. Moreover, Statistical analysis revealed that, each of Tangible Dimension, Healthcare Service Quality Dimension and Empathy Dimension, is positively correlated with Healthcare Service Quality. Likewise, Healthcare Service Quality, is also positively correlated with residents’ satisfaction. But Reliability, Responsiveness, and Assurance Dimensions, are not positively correlated with Healthcare Service Quality.

Client Satisfaction and Quality of Life at Primary Healthcare Clinics and Psychiatric Hospitals in the Eastern Province of Saudi Arabia

Over the past few years, greater attention has been paid to the importance of incorporating behavioral health treatment into primary health care (PHC) settings in the Kingdom of Saudi Arabia (KSA). The purpose of the present study was to compare the participants’ satisfaction on psychological services and quality of life (QOL) among primary healthcare clinics, psychiatric hospitals and healthy controls. The Arabic version of the World Health Organization Quality of Life-short version (WHOQOL-Bref) and Client Satisfaction Questionnaire (CSQ) were administered to 36 PHC participants, 60 hospital participants, and 63 healthy controls. In all QOL domains, there was no significant difference obtained on participants’ QOL between PHC and hospital settings. Except for similar score to PHC participants on overall QOL (OQOL), healthy controls scored higher than the other two groups on four QOL domains and General Health (GH) facet. As for clients’ satisfaction, participants under PHC setting reported significantly higher satisfaction compared to hospitals and healthy controls. Hospital participants reported higher client care satisfaction than healthy controls. Improvement in the quality of mental health care such as ease of referrals and detection of undiagnosed mental health conditions could be the cause for higher satisfaction with PHC services. Stigma associated with mental illness creates serious barriers to Saudi patient’s access to psychiatric clinics of large hospitals. There is a need for incorporating qualified mental health providers into PHC and educating the general public to become aware of certain beliefs and attitudes that limit access to treatment and prospects for recovery of persons with mental illnesses.

Does Quality of Care Differ When HIV Patients Are Treated by Non-Specialist and Specialist HIV Healthcare Providers in Developed Countries? A Systematic Narrative Review

Introduction: In developed countries, HIV care is mostly provided by trained specialist healthcare professionals. Due to the increasing demand for HIV care, pressure on healthcare providers to reduce cost and the current global economic constraints, many developed countries are searching for alternative HIV care models. This review aims to consider whether HIV treatment and care can be provided as effectively and safely by doctors and nurses with no HIV-specialist training compared to those with HIV-specialist training. Methods: Three electronic bibliographic databases MEDLINE, EMBASE and the Cochrane Library were searched for studies conducted between January 1996 and March 2015. Manual searches of reference lists of all relevant reports retrieved from the electronic databases were conducted. All comparative studies examining the quality of HIV care provided by different types of healthcare providers in developed countries were included. Results: Nine observational studies involving 27,015 patients were included in the review. Eight studies were conducted in the USA and one study in Switzerland. Healthcare providers with HIV-related expertise and or training and those without HIV-related expertise or training who collaborated with providers with HIV-related expertise and or training outperformed other healthcare providers in many virological, immunological and ART-related outcomes. Conclusion: This review found moderate quality evidence that HIV care can be provided effectively by non-HIV specialists if they have access to HIV specialists or experts for advice and support.

Quality in Healthcare: The New Frontier of“Patient-Centered Care Approach” in Day Clinics

This article aims to study methodologically hospital buildings and, in particular, the design of day clinics in the recovery area. The definition of design guidelines to improve and qualify the day clinic, enhancing their performance, takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the massive evolution in health organizations. Changes in medicine, culture and society have necessarily led to a new formulation of the hospital model and the introduction of the theme of the humanization of the curing process has conditioned the morphological-space configuration and the presence of new relationships and spatial functions in the hospitals. The research of this article attempts, therefore, to explore the use of technology to improve the quality of day clinics’ design, formulating strategies that contribute on one side to facilitating the efficiency of service, and on the other side to making the user feel at ease in a welcoming and comfortable environment.

Evaluation of Quality of Healthcare Service Avaeilable to People Living with HIVIAIDS： Evidence from Enugu State

The study evaluated the quality of healthcare services given to PLWHA （people living with HIV/AIDS） in different communities of Enugu State of Nigeria. Descriptive cross sectional survey design was employed for the study. The participants were PLWHA attending health facilities in different communities in the state. A sample of 180 PLWHA who participated in the study were selected using a multi-stage sampling procedure and were interviewed at community level. The data were analyzed using descriptive statistics. The results showed that 82.2% of the respondents were cared for by government health facilities, 75% were of the opinion that the health workers in those places do not discriminate against them, 81.7% felt that they were being given high quality healthcare, 82.8% stated that their drugs were readily available, 75% were of the opinion that the physical facilities in their care centers were adequate, 84.4% felt that grievance redressing were good while 90% felt that their healthcare providers maintain confidentiality about their conditions. It was concluded from the findings that quality of care provided to PLWHA in communities was of good quality as perceived by PLWHA and that the national antiretroviral programmes are making drugs available and affordable in the state. It was then recommended that all levels of government in the nation should strengthen the programmes on HIV prevention and control to maintain the continuity of care to PLWHA.

Sociodemographic Predictors of Health-Related Quality of Life and Healthcare Service Utilisation among Young Refugees in South Australia

Although refugee adolescents and children are recognised as a health risk population, few studies have explored their Health-related Quality of Life (HRQOL). The present study investigated 1) the sociodemographic predictors of HRQOL such as ethnicity, trauma exposure, and length of residency in Australia in a multiethnic paediatric population with refugee experiences and 2) the relationship between mental healthcare utilisation and HRQOL. Method: Participants were 458 adolescents and children, aged 4 - 17 years, living in South Australia. Parents provided data across the sample and adolescents also completed questionnaires. Overall HRQOL and its composite functional dimensions were assessed using the Paediatric Quality of Life (PedsQL) instrument. Questions from the Child and Adolescent Component of the Australian National Survey of Mental Health and Wellbeing were used to assess service utilisation. Results: Migration region/ethnicity predicted better HRQOL as well as physical, emotional and psychosocial functioning for both children and adolescents. African youths indicated higher HRQOL than those from the former Yugoslavia and the Middle East/South Asia respectively. Pre-migration trauma exposure was associated with lower HRQOL;and longer stay in Australia was related to lower emotional functioning in children. There was a negative association between healthcare service utilisation and PedsQL scores, with participants accessing services demonstrating lower HRQOL. Conclusion: Using more rigorous methods, future research is needed to investigate additional sociodemographic predictors of HRQOL, and protective/risk factors that impact on HRQOL of young refugees.

Effect of Storage Time on Main Quality Indicators of Cotton

The quality indicators of cotton will change during storage.Taking the 5.89 million t of Xinjiang cotton from 2016 to 2021 as a sample,this paper analyzed the main fiber quality indicator data of warehouse-in and warehouse-out cotton for storage of 1.5,3.0,4.0,5.0,6.0,and 7.0 years.It was found that the color grade of cotton decreased with the extension of storage time.The cotton with storage time of 5.0 years mainly changed from white cotton grade 2 and white cotton grade 3 to light yellow stained cotton grade 1 and yellow stained cotton grade 1.Among them,the increase of light yellow stained cotton grade 1 was the largest,and the change to yellow stained cotton grade 1 was the largest at the storage 6.0-7.0 years.In addition,there were no significant changes in moisture regain,Micronaire value,upper half mean length,length uniformity index and fiber strength.