Effectiveness of Treatment Outcomes of Public Private Mix Tuberculosis Control Program in Eastern Nigeria

Effective tuberculosis treatment has been shown to have significant effect on the control of tuberculosis. Completion of treatment of active cases is therefore the most important priority of tuberculosis control programmes. Descriptive statistics with a retrospective cohort study design used to analyze secondary data set (2007-2010) of patients accessing TB-DOTS treatment in two facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health Services Tuberculosis and Leprosy  Control Unit Nnewi North Local Government Area (L.G.A.) Secretariat, DHSTLCU ) as public health facilities and other two facilities ( Immaculate Heart of Catholic Church Hospital, IHCCH  and Diocesan Anglican Communion Hospital, DACH) as private health facilities in Nnewi North L.G.A., Anambra State. Gender of patients were male: female 54%(1016 patients) : 46% (883 patients) and 53%(63 patients) : 47%(56 patients) in public and private health facilities respectively . Using WHO (1996) standards the health facilities adjudged as efficient were: in 2007, private facilities using the indicator  of treatment failure rate; private facilities using the indicator of death rate;  public facilities and private facilities using  the indicator of transfer-out rate ; public facilities using the indicator of  treatment completion rate. In 2008, effective health facilities were: private health facilities using the indicator of failure rate; public and private health facilities using the indicator of transfer-out rate; private facilities using the indicator of treatment completion rate. In 2009, effective health facilities were public and private health facilities using indicator of treatment failure rate; public and private health facilities using the indicator of death rate; public and private facilities using the indicator of transfer out; public and private facilities using the indicator of treatment completion rate. In 2010, effective health facilities were: private health facilities using the indicator of  cure rate; private facilities using the indicator of death rate ; public and private facilities using the indicator of transfer-out; public facilities using the indicator of treatment completion rate. In conclusion, private health facilities were more effective than public health facilities  by the several indicators over the four year period.  Future research is needful to use primary and secondary data sets in assessment of TB control program effectiveness; technical efficiency assessment using non-parametric statistics will assess the validity of assessing effectiveness using only the WHO standards; identify centre-specific factors associated with poor treatment outcome; institutionalizing a reward system for effective TB-DOTS facilities will engender healthy competition in the Public Private Mix for sustained effectiveness; the Monitoring and Evaluation tools especially the treatment card for data capture should be improved upon for comprehensiveness of patients socio-economic history. Keywords: Tuberculosis, Effectiveness, Treatments Outcomes, Public Private Mi

Technical efficiency of public district hospitals and health centres in Ghana: a pilot study

BACKGROUND: The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination) in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i) to estimate the relative technical efficiency (TE) and scale efficiency (SE) of a sample of public hospitals and health centres in Ghana; and (ii) to demonstrate policy implications for health sector policy-makers. METHODS: The Data Envelopment Analysis (DEA) approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. RESULTS: Eight (47%) hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD) of 12%. Ten (59%) hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%). Out of the 17 health centres, 3 (18%) were technically inefficient, with a mean TE score of 49% (STD = 27%). Eight health centres (47%) were scale inefficient, with an average SE score of 84% (STD = 16%). CONCLUSION: This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres) in the course of the implementation of health sector reforms

Access to Care for VA Dialysis Patients During Superstorm Sandy.

Introduction: This study examines the use of dialysis services by end-stage renal disease (ESRD) patients following the Superstorm Sandy-related, months-long closure of the New York campus of the US Department of Veterans Affairs (VA) New York Harbor VA Healthcare System (NYHHS, Manhattan VAMC). Methods: Outpatient visits, dialysis care, emergency department visits, and hospitalizations at VA and non-VA facilities for 47 Manhattan VAMC ESRD patients were examined 12 months pre- and post-Sandy using VA administrative and clinical data. Results: The Brooklyn campus of NYHHS, which is within ten miles of Manhattan VAMC, experienced the largest increase in the number of dialysis encounters after the closure. Dialysis encounters for VA patients also increased at non-VA facilities, rising on average, to 106 per month. For the James J Peters Bronx VAMC, the number of total dialysis encounters for Manhattan VAMC patients fluctuated between 39 and 43 per month, dropping to less than 30 after the Manhattan VAMC dialysis unit reopened. Conclusion: Manhattan VAMC ESRD patients used nearby alternate VA sites and non-VA clinics for their care during the closure of the Manhattan VAMC dialysis unit. The VA electronic health records played an important role in ensuring continuity of care for patients who exclusively used VAMC facilities post-Sandy because patient information was immediately accessible at other VA facilities. The events related to Superstorm Sandy highlight the need for dialysis providers to have a comprehensive disaster plan, including nearby alternate care sites that can increase service capacity when a dialysis facility is closed because of a disaster

Infection prevention and control in healthcare facilities in Albania

Aim: The objective of this study was to assess the current status regarding Infection Prevention and Control (IPC) in selected healthcare facilities in Albania in light of the ongoing COVID-19 pandemic which continues unabated.     Methods: A cross-sectional study was conducted in April 2021 including a nationwide representative sample of 505 health professionals working mostly in primary health care centres in Albania (84 men and 421 women; response rate: 95%). A structured questionnaire developed by the World Health Organization was administered online to all participants inquiring about a wide range of measures and practices employed at health facility level for an effective IPC approach. Fisher’s exact test was used to assess potential urban-rural differences in the distribution of characteristics regarding IPC aspects reported by survey participants.         Results: About 47% of health facilities did not have a designated focal point for IPC issues; the lack of one patient per bed standard was evident in more than one-third of health facilities (37%); and the lack of an adequate distance between patient beds was reported in a quarter of health facilities (which was twice as high among health facilities in urban areas compared to rural areas). Furthermore, water services were always available only in about two-thirds of health facilities (63%), whereas an adequate number of toilets (at least two) was evident in slightly more than half of the health facilities surveyed (53%). Also, one out of four of the health facilities did not have functional hand hygiene stations and/or sufficient energy/power supply. A completely adequate ventilation was evidenced in slightly more than half of the health facilities (51%). Four out of five health facilities had always available materials for cleaning and about half (49%) had always available personal protective equipment. Functional waste collection containers were available in nine out of ten health facilities, of which, four out of five were correctly labelled.   Conclusion: This study informs about the existing structures, capacities and available resources regarding IPC situation in different health facilities in Albania. Policymakers and decision-makers in Albania and in other countries should prioritize investments regarding IPC aspects in order to meet the basic requirements and adequate standards in health facilities at all levels of care

Infection prevention and control in healthcare facilities in Albania

  Aim: The objective of this study was to assess the current status regarding Infection Prevention and Control (IPC) in selected healthcare facilities in Albania in light of the ongoing COVID-19 pandemic which continues unabated.     Methods: A cross-sectional study was conducted in April 2021 including a nationwide representative sample of 505 health professionals working mostly in primary health care centres in Albania (84 men and 421 women; response rate: 95%). A structured questionnaire developed by the World Health Organization was administered online to all participants inquiring about a wide range of measures and practices employed at health facility level for an effective IPC approach. Fisher’s exact test was used to assess potential urban-rural differences in the distribution of characteristics regarding IPC aspects reported by survey participants.         Results: About 47% of health facilities did not have a designated focal point for IPC issues; the lack of one patient per bed standard was evident in more than one-third of health facilities (37%); and the lack of an adequate distance between patient beds was reported in a quarter of health facilities (which was twice as high among health facilities in urban areas compared to rural areas). Furthermore, water services were always available only in about two-thirds of health facilities (63%), whereas an adequate number of toilets (at least two) was evident in slightly more than half of the health facilities surveyed (53%). Also, one out of four of the health facilities did not have functional hand hygiene stations and/or sufficient energy/power supply. A completely adequate ventilation was evidenced in slightly more than half of the health facilities (51%). Four out of five health facilities had always available materials for cleaning and about half (49%) had always available personal protective equipment. Functional waste collection containers were available in nine out of ten health facilities, of which, four out of five were correctly labelled.   Conclusion: This study informs about the existing structures, capacities and available resources regarding IPC situation in different health facilities in Albania. Policymakers and decision-makers in Albania and in other countries should prioritize investments regarding IPC aspects in order to meet the basic requirements and adequate standards in health facilities at all levels of care

Heat-Ready: heatwave awareness, preparedness and adaptive capacity in aged care facilities

AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.Please cite this report as: Black, DA, Veitch, C, Wilson, LA, Hansen, A 2013 Heat-Ready: Heatwave awareness, preparedness and adaptive capacity in aged care facilities in three Australian states: New South Wales, Queensland and South Australia, National Climate Change Adaptation Research Facility, Gold Coast, 47 pp.AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.&nbsp

Prev Chronic Dis

Use of artificial tanning may be contributing to the increased incidence of skin cancer. Federal law requires warning signs to inform consumers about health risks. All of the tanning facilities in New York City were assessed for compliance with this law during April and May 2010. More than one-third of the 224 tanning machines observed in 47 of the 85 facilities visited did not have any warning signs posted, and signs were difficult to see in many others

Dying in long-term care facilities in Europe : the PACE epidemiological study of deceased residents in six countries

Background: By 2030, 30% of the European population will be aged 60 or over and those aged 80 and above will be the fastest growing cohort. An increasing number of people will die at an advanced age with multiple chronic diseases. In Europe at present, between 12 and 38% of the oldest people die in a long-term care facility. The lack of nationally representative empirical data, either demographic or clinical, about people who die in long-term care facilities makes appropriate policy responses more difficult. Additionally, there is a lack of comparable cross-country data; the opportunity to compare and contrast data internationally would allow for a better understanding of both common issues and country-specific challenges and could help generate hypotheses about different options regarding policy, health care organization and provision. The objectives of this study are to describe the demographic, facility stay and clinical characteristics of residents dying in long-term care facilities and the differences between countries. Methods: Epidemiological study (2015) in a proportionally stratified random sample of 322 facilities in Belgium, Finland, Italy, the Netherlands, Poland and England. The final sample included 1384 deceased residents. The sampled facilities received a letter introducing the project and asking for voluntary participation. Facility manager, nursing staff member and treating physician completed structured questionnaires for all deaths in the preceding 3 months. Results: Of 1384 residents the average age at death ranged from 81 (Poland) to 87 (Belgium, England) (p < 0.001) and length of stay from 6 months (Poland, Italy) to 2 years (Belgium) (p < 0.05); 47% (the Netherlands) to 74% (Italy) had more than two morbidities and 60% (England) to 83% (Finland) dementia, with a significant difference between countries (p < 0.001). Italy and Poland had the highest percentages with poor functional and cognitive status 1 month before death (BANS-S score of 21.8 and 21.9 respectively). Clinical complications occurred often during the final month (51.9% England, 66.4% Finland and Poland). Conclusions: The population dying in long-term care facilities is complex, displaying multiple diseases with cognitive and functional impairment and high levels of dementia. We recommend future policy should include integration of high-quality palliative and dementia care

What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal.

Introduction: Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal. Methods: For this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans. Results: Births in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral. Conclusions: Our findings imply that many lower-level public facilities-the most common place of birth in Senegal-are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality