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.

HIV/AIDS Related Discrimination in Health Care Service:a Cross-sectional Study in Gejiu City, Yunnan Province

Objectives To investigate discrimination against people living with HIV （PLWH） and its impacts. Methods Forty people who were either HIV positive （7/40） or had high risk behavior （33/40） were interviewed. Focus group discussion was held in the interview with people who were suspected to be infected with HIV, and in-depth interview was conducted in the survey of HIV positive persons whose privacy was strictly protected to ensure the confidentiality of the collected information. Results It was identified that six forms of discrimination against people living with HIV occurred in health care service in Gejiu, including speaking to patients in an insulting manner, refusing to provide health care service, delaying treatment, treating differently, uncovering patients＇ privacy, and over-protecting themselves against patients. Discrimination against people living with HIV greatly affected their health conditions. Conclusions Discrimination against people living with HIV in health service has negative impact on their physical and mental health.

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.

The Management of Mental Health, and Service Networks in Italy

Madness has attracted and frightened for centuries,and talking about this means discussing how this diversity was built and managed in different social contexts and historical periods.Not all societies have had,and still have,the same relationship with madness.It is only with the affirmation of the Modern State,and of Capitalism,that the idea of“normality”indispensable to be able to conceive diversity as something dangerously distant and different from the norm takes over.In our post-modern society,people with mental illness in Italy can resort to specialists and social-health services.But the heterogeneous answers given after the approval of law 180 appear to be increasingly diversified.In this research,much attention will be paid to how the social and health services,located in different areas of Italy(Messina,Rome,Trento)face the current growing risk of social,housing and economic isolation of these fragile subjects.The aim of the research is to explore the possibility of a new relationship between the social-health service and the local community.On the one hand,research investigates what the contribution of the services could be.On the other what the spaces of protagonism and participation of the community could be in inclusion process account.In order to better understand the differences between these two dimensions,a qualitative research approach was chosen through the conduct of in-depth interviews.In this way it was possible to investigate:(1)the partial representations characteristic of the single individual,family members,operators and stackholders in general;(2)the services around the topic dealt with is articulated.From the first results of the research it emerges that the territory can no longer be considered as an abstract entity,but becomes the social space within which the construction of a new community welfare can and must take place.

Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

Background: Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objectives: To operationalize adolescent health services at primary health care level in a block of Maharashtra;assess impact of need based interventions on quality of services;and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Centers (A&YFHCs). Attitude of providers to address adolescents’ needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents;it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram— the new national adolescent health programme in India.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

Inter-organizational cooperation: A rehabilitation project based on cooperation between health care and three social service agencies

Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.

Users’ Perception and Satisfaction of Current Situation of Home Health Care Services in Jordan

Background: The healthcare system in Jordan is evolving and has to continuously respond to the changing risk profile of the population. The purpose of this study was to examine perception of users and providers of the quality of home health care services. Methods: A descriptive design was used to collect data from a convenience sample of 82 users of home health care services. Results: Users had low to fair satisfaction (30.5% - 69.5%) about the quality of care provided, had moderate satisfaction (72.0% to 81.7%) about the information received, and had low to fair satisfaction about education related to goal of treatment and medication (46.4% - 53.3%). Users had high level of agreement (>70%) that health agencies provided interpersonal care. Conclusion: The ability of the frail people to choose from a variety of cost-effective long-term care services is limited.

Accessibility and availability of health care services to internally displaced persons, in Kitgum and Pader districts, northern Uganda

Introduction: During 1986-2009, an estimated 1.6 million persons were internally displaced from northern and eastern regions of Uganda due to civil war. We investigated accessibility to and availability of health care services for the internally displaced persons in Kitgum and Pader districts, northern Uganda. Methods: This was a cross-sectional study conducted in Kitgum and Pader districts, northern Uganda. We interviewed a total of 1383 respondents comprising 968 (70%) adults and 415 (30%) adolescents;60% were females and 40% males, randomly selected from 35 of 67 (52.2%) internally displaced persons (IDP) camps. We held 27 key informant interviews and 52 focus group discussions. Data were entered in EPI data version 3.02 and analysed using SPSS version 12.00 statistical packages. Findings: Two thirds of the respondents 67.5% lived within 5 km distance of a health facility. The majority 62.9% of respondents mentioned that health related information was readily provided. 43.5% of health providers were always available in a health facility. A quarter 25.1% of health facilities always had drugs available, while 56.9% of the drugs prescribed were always available. Two thirds of the respondents 65.9% were satisfied with the health care services provided. The main reasons for the choice of a health facility were proximity 29.6%, provision of free treatment 24.7% and availability of drugs 17.2%. Main barriers to health care access were due to the lack of financial resources, trained personnel, and inadequate drugs and supplies in the health facilities. Conclusions and Recommendations: The majority of IDPs lived in close proximity to health facilities and obtained health care services from public health facilities. Access to health care was determined mainly by proximity and availability of free services and drugs. Although geographic accessibility to health services was high, lack of finances, information and decision power hindered access to health care services.

Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

Suicide Prevention in Mental Health Services—A Qualitative Study of a Web Based Program for Mental Health Care Staff

Background: Further strategies are needed to deal with the high losses to suicide. New modalities should be explored within the context of suicide prevention. Aim: The aim of the study was to evaluate participants’ experiences of a web based program for mental health care staff, including its potential clinical relevance. Methods: Nineteen participants participated in five focus groups. Data was analyzed using content analysis. Results: The analysis showed participants’ experiences of the program’s contents and format (“Web Based Modules”, “Discussion Groups”) and practical value (“Clinical Relevance and Use”, “Effects on Communication and Climate”). Conclusions: The program partly increased awareness about risk factors and the importance of inquiring about suicide ideation/plans and documenting suicide assessments. Experiences of the clinical value were varying and may be increased through potential enhancements.

Health Care Service Improves in Aba

Before liberation,there were only six public health stations and two missionary hospitals in Aba.The number of medical institutions,however,has shot up to 499 there.

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Caring for Individuals with Early-Onset Dementia and Their Family Caregivers: The Perspective of Health Care Professionals

The phenomenon of early-onset dementia remains an under-researched subject from the perspective of health care professionals. The aim of this qualitative study was to document the experiences and service needs of patients and their family caregivers for optimal clinical management of early-onset dementia from the perspective of health care professionals. A sample of 13 health care professionals from various disciplines, who worked with individuals who suffered from Alzheimer’s disease or related disorders and their family caregivers, took part in focus groups or semi-structured individual interviews, based on a life course perspective. Three recurrent themes emerged from the data collected from health care professionals and are related to: 1) identification with the difficult experiences of caregivers and powerlessness in view of the lack of services;2) gaps in the care and services offered, including the lack of clinical tools to ensure that patients under age 65 were diagnosed and received follow-up care, and 3) solutions for care and services that were tailored to the needs of the caregiver-patient dyads and health care professionals, the most important being that the residual abilities of younger patients be taken into account, that flexible forms of respite be offered to family caregivers and that training be provided to health care professionals. The results of this study provided some innovative guidelines for optimal clinical management of early-onset dementia in terms of the caregiver-patient dyad.

Determinants of Antenatal Health Care Utilization in Egypt (2000-2014) Using Binary and Count Outcomes

Aim: This study seeks to investigate the factors determining the utilization of antenatal care services, the frequency of that use, and the timing of receiving antenatal care among Egyptian women utilizing a national representative data from Egypt Demographic and Health Surveys (EDHS) in 2000 and 2014. Methods: The paper estimates the logistic regression model, zero-inflated negative binomial model (ZINB), and negative binomial regression model (NB) to identify the most important determinants of antenatal health care utilization. Results: The findings indicate that the period 2000-2014 has experienced a significant increase in the use of antenatal health care services. The use of the public sector antenatal care services relative to that of the private sector has been decreasing over time. Moreover, wealth index, women’s education and quality of health services play significant roles in increasing accessibility of antenatal health care services. On the other hand, women’s empowerment has shown a positive effect in 2000 only. Conclusion: The study highlights the most vulnerable groups that are less likely to have access to antenatal health care services, mainly women who are less educated, poor and living in rural areas especially Upper Egypt. This certainly requires a more targeted health strategy with an equity lens.

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.