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Despite global progress in childhood vaccination coverage, fragile and humanitarian countries, with high burden of infectious diseases, continue to report a significant number of zero-dose and under-vaccinated children. Efforts to equitably reach zero-dose children remain thus critical. This study assesses the prevalence and determinants of zero-dose children in fragile context of Somalia. We used secondary data from 2020 Somali Health and Demographic Survey (SHDS) to determine status of unvaccinated children aged between 12 to 23 months. Variables related to socio-demographic, household, health seeking, and community level factors were extracted from the SHDS data. Variables that were shown to be significantly associated with zero-dose children at p< 0.05 in the single logistic regression analysis were identified and included in a final multiple logistic regression analysis. A total of 2,304 women and their children aged between 12–23 months were used to determine the prevalence and determinants of zero dose children in Somalia. Approximately 60.2% of the children were zero dose children and did not receive any dose of the four basic routine vaccines. Children living in rural and nomadic areas were more likely to be zero dose (aOR 1.515, 95% CI: 1.189–1.93). Mother with primary education and above (aOR 0.519, 95% CI: 0.371–0.725), those who attended antenatal care (aOR 0.161, 95% CI: 0.124–0.209) and postnatal care (aOR 0.145, 95% CI: 0.085–0.245) and listen frequently to radio (aOR 2.212, 95% CI: 1.106–4.424) were less likely to have children with zero dose than with their counterparts. Majority of children under two years of age in Somalia are reported to be zero dose children. Context and population specific interventions that target vulnerable mothers and their children, in rural and nomadic areas, and from lower wealth quintile index families with no education and adequate access to antenatal and postnatal care remain critical.
Extrapulmonary Tuberculosis (EPTB) poses challenges from patient and health system perspectives. The cost-effectiveness analysis of the Xpert MTB/RIF (Xpert) test to diagnose pulmonary tuberculosis is documented. However, there are no economic evaluations for EPTB. Considering the reported better diagnostic sensitivity of the MPT64 test, this study explored its cost-effectiveness as an alternative diagnostic test. We conducted this economic evaluation to assess the cost-effectiveness of the MPT64 test compared to Xpert and ZN microscopy for EPTB adult patients. We utilised a Markov modelling approach to capture short- and long-term costs and benefits from a health system perspective. For the model inputs, we combined data from our cohort studies in Tanzania and peer-reviewed EPTB literature. We calculated the Incremental Cost Effectiveness Ratio (ICER) by comparing the cost (in USD) of each diagnostic test and Quality Adjusted Life Years (QALYs) as health gain. We found the MPT64 test cost-effective for EPTB diagnosis and absolutely dominated ZN microscopy and Xpert using the baseline model inputs. A scenario analysis showed that the Xpert test might be the most cost-effective at its higher test sensitivity, which corresponds to using it to diagnose lymph node aspirates. The prevalence of HIV among EPTB cases, their probability of treatment, costs of ART, and the probability of the MPT64 test in detecting EPTB patients were the main parameters associated with the highest impact on ICER in one-way deterministic analysis. The most cost-effective option for EPTB at the baseline parameters was the MPT64 diagnostic test. Including the MPT64 test in EPTB diagnostic pathways for previously untreated patients can lead to better resource use. The Xpert test was the most cost-effective diagnostic intervention at a higher diagnostic test sensitivity in scenario analyses based on different sites of infection, such as for the lymph node aspirates.
Extrapulmonary Tuberculosis (EPTB) poses challenges from patient and health system perspectives. The cost-effectiveness analysis of the Xpert MTB/RIF (Xpert) test to diagnose pulmonary tuberculosis is documented. However, there are no economic evaluations for EPTB. Considering the reported better diagnostic sensitivity of the MPT64 test, this study explored its cost-effectiveness as an alternative diagnostic test. We conducted this economic evaluation to assess the cost-effectiveness of the MPT64 test compared to Xpert and ZN microscopy for EPTB adult patients. We utilised a Markov modelling approach to capture short- and long-term costs and benefits from a health system perspective. For the model inputs, we combined data from our cohort studies in Tanzania and peer-reviewed EPTB literature. We calculated the Incremental Cost Effectiveness Ratio (ICER) by comparing the cost (in USD) of each diagnostic test and Quality Adjusted Life Years (QALYs) as health gain. We found the MPT64 test cost-effective for EPTB diagnosis and absolutely dominated ZN microscopy and Xpert using the baseline model inputs. A scenario analysis showed that the Xpert test might be the most cost-effective at its higher test sensitivity, which corresponds to using it to diagnose lymph node aspirates. The prevalence of HIV among EPTB cases, their probability of treatment, costs of ART, and the probability of the MPT64 test in detecting EPTB patients were the main parameters associated with the highest impact on ICER in one-way deterministic analysis. The most cost-effective option for EPTB at the baseline parameters was the MPT64 diagnostic test. Including the MPT64 test in EPTB diagnostic pathways for previously untreated patients can lead to better resource use. The Xpert test was the most cost-effective diagnostic intervention at a higher diagnostic test sensitivity in scenario analyses based on different sites of infection, such as for the lymph node aspirates.
Malaria remains a substantial global health challenge, causing preventable illnesses and fatalities. In Nepal, the government has ambitiously targeted achieving malaria-free status by 2025. This study aims to assess the impact of women’s roles on health-seeking behavior during suspected malaria fever in the high-risk area of Kanchanpur district, Nepal. This is a cross-sectional analytical design with a mixed-method approach, the research focused on Kanchanpur district, selected from 20 high-risk malaria districts of Nepal. Belauri Municipality within Kanchanpur, identified for its concentration of high and moderate-risk wards, was the specific study area. A random selection process identified 387 households for a comprehensive survey. Face-to-face interviews with household heads were conducted after obtaining written informed consent and ethical approval from the Nepal Health Research Council (March 3, 2023/Ref no.-2041). Data analysis, employing statistical measures such as percentages, frequency, mean, and the Chi-square test, was performed using SPSS version 20. Cultural beliefs regarding women’s use of bed nets during menstruation significantly predicted health-seeking behavior (p-value < 0.05). Those endorsing bed net use during menstruation were nearly twice as likely to choose modern health facilities (COR = 1.975, 95% C.I. = 1.134 to 3.439, p = 0.016). Women’s involvement in malaria treatment decisions strongly correlated with health-seeking behavior (p-value = 0.001). However, women participating in household decisions for suspected malaria treatment were less likely to choose modern health facilities (COR = 0.327, 95% CI = 0.171–0.627, p = 0.001) compared to those without such a role. The study underscores the complex influence of cultural beliefs and women’s decision-making roles on health-seeking behavior. Recognizing and comprehending these factors are vital for crafting effective malaria interventions that align with cultural contexts and consider the nuanced roles of women in health-related decisions.
Childhood overweight and obesity due to unhealthy diet result in several adverse effects. Mothers play a major role in selecting snacks for younger children. This study assessed the factors associated with the choice of packaged food/beverage snacks among mothers of 6- to 10-year-old children in the Medical Officer of Health area Balangoda. A community-based descriptive cross-sectional study with an analytical component was conducted in 2022 among 450 mothers with 6- to 10-year-old children through two-stage, stratified (year of birth considered as a stratum), simple random sampling technique in ten randomly selected Public Health Midwife areas in the medical officer of health area Balangoda. An interviewer-administered questionnaire was used to assess participants’ sociodemographic, usual practices, attitudes, and knowledge toward packaged snacks. Factors associated with maternal practices related to packaged snack selection were assessed through the chi-square test at the p<0.05 significance level. The response rate was 99.3% (N = 447). Children were commonly provided with biscuits (94.4%) and flavoured milk (44.7%) daily (66.4%) at home (93.5%). The majority of mothers reported poor practices in selecting packaged snacks (88.8%), but good knowledge (62.9%) and favorable attitudes (93.5%) toward packaged snacks. The majority (75.5%) were aware that snacks are important for overcoming the hunger gap among children. Childs’ preference (77.6%) was the leading influencing factor while, the nutritional value of the packaged snacks minimally influenced the maternal (2.7%) choice. Only 49.9% mothers knew that packaged fruits could be consumed as snacks. Maternal Sinhalese ethnicity (p<0.001), secondary or higher education (p<0.001), having one child (p = 0.003), residing in a rural or urban area (p = 0.011) and having favourable attitudes (p = 0.002) were significantly associated with poor maternal practices in packaged snack selection. Although mothers’ knowledge toward packaged snacks were good, their practices in selecting packaged snacks were poor. Maternal ethnicity, educational level, number of children, area of residence and attitudes were significantly associated with mothers’ selection of packaged snacks. The results of the study highlighted the need to plan, develop and implement focused health promotion programmes to empower mothers to select healthier packaged snack options for their 6- to 10-year-old children.
Burn injury is a major contributor to morbidity and mortality in developing countries. In Ethiopia, the outcome of burn injuries and associated factors among burn patients were not clearly described. To assess the outcome of burn injuries and its associated factors among burn patients attending public hospitals in the North, showa Zone, Ethiopia. An institution-based cross-sectional study was conducted among 420 burn patients in public hospitals of the North showa, zone. Systematic random sampling was used to select study participants. Structured checklists were used to extract data from burn patients’ medical records. Data was entered using Epi-Data version 4.6. Data was analyzed using SPSS version 25. A p- value of ≤ 0.05 in the multivariable logistic regression was used to declare a significant association. In this study, the prevalence of discharges with complications was 40.9% (95% CI: 36.5–45.6). The odds of developing complications among patients having pre-hospital intervention were nearly four times the odds of not having the intervention (AOR = 3.8, 95% CI, 1.11–13.25). The odds of developing complications among patients having scalds were four times the odds of not having scalds (AOR = 4.3, 95% CI, 1.52–12.32). A patient who received fluid and electrolytes was 76% less likely to develop the outcome of burn injury discharged with burn complications. Patients with TBSA less than 20% were 66% less likely to be discharged with complications compared to patients with TBSA greater than 20%.: This study demonstrates a significantly higher level of outcome for patients with burn injuries who were discharged with complications, leading to death and other bad outcomes. Therefore, stakeholder would more emphasis in health education on prevention of burn injuries, first aid treatment of burn, treatment of the cause of burns, and providing fluid and electrolytes.
Limited data among miners in Tanzania suggests prevalence of silicosis, obstructive lung disease and restrictive lung disease to be around 1.6%, 1.9% and 8.8% respectively. Our study aimed to determine the prevalence and factors associated with silicosis and impaired lung function among tanzanite mining community in northern Tanzania. We conducted a cross-sectional study, involving 330 miners and 330 peri-mining community members in Mererani mines. Silicosis was defined based on study participants’ history of exposure to mining dust and digital chest radiological findings with reference to the 2011 ILO classification of pneumoconiosis. Impaired lung function was determined by spirometry using American Thoracic Society/European Respiratory Society recommended system 3. Association between evidence of silicosis/impaired lung function and presumed risk factors were determined using binary logistic regression analyses. The study found that 99/330 (30.0%) of miners had silicosis. Total of 65 (9.8%) participants had impaired lung function, of whom 29 (4.4%) had Chronic Obstructive Pulmonary Disease, 32 (4.8%) had restrictive lung disease and 4 (0.6%) had both obstructive and restrictive lung diseases. Unexpectedly, miners who have worked for more than 10years and those worked for 6 to 10 years had 64% (aOR 0.34, CI = 0.17–0.67, p = 0.002) and 48% (aOR 0.52, CI = 0.30–0.89, p = 0.018) lower odds of having silicosis respectively compared those worked for up to 5 years. Participants with more than 10 years of work duration had more than 3-times higher odds of impaired lung function compared to those who had worked for up to 5 years (aOR 3.11, CI = 1.53–6.34, p<0.002). We found a concerningly high prevalence of silicosis despite short durations of exposure to occupational silica dust. Immediate dust control measures including deployment of wet drilling, wearing of personal protective equipment and regular monitoring of dust exposure need to be enforced by the Occupational Safety and Health Authority–Tanzania.
Data Owner:
University Medical Center Utrecht
This study examined the factors influencing the decision-making of primary care physicians and nurses in providing self-management support to patients with chronic diseases. The aim of this research was to determine the relative importance of various patient factors in health professionals' decision-making.
Data Owner:
Curtin University
Objectives This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services. Design Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews. Setting Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015. Participants Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed. Main outcome measures Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services. Results 15 621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016. Conclusions This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered.
Objectives: To estimate hepatitis B vaccination (HBVc) coverage, and knowledge and socio-demographic determinants of full-dose uptake in Federal Road Safety Corps (FRSC) members, Kaduna State, Nigeria in order to inform relevant targeted vaccination policies. Design: A cross-sectional survey of FRSC members, Kaduna Sector Command. Settings: Six randomly-selected Unit Commands under Kaduna Sector Command, Kaduna State, Nigeria. Participants: Pilot-tested structured self-administered questionnaire was administered to 341 participants aged 18 years and above with ≥6 months of service between 17th June and 22nd July, 2015. Excluded were FRSC members in Road Safety (RS) 1 Zonal Command headquarters as the Zonal Command includes other States beyond the study scope. Primary Outcome: HBVc status of participants categorized as ‘not vaccinated’ for uptake of <3 doses and ‘vaccinated’ for uptake of ≥3 doses. Analysis: Descriptive analysis estimated HBVc coverage while logistic regression ascertained associations. Results: Most participants were males, aged 30-39 years, with 3-10 years of service, and of Marshal cadre. HBVc coverage was 60.9% for ≥1 dose and 30.5% for ≥3 doses. Less than 47% of participants scored above the mean knowledge score for hepatitis B virus (HBV) and HBVc. Female sex (AOR 2.28, 95% CI 1.15-4.52, p<0.05), perceiving there to be an occupational risk of exposure to HBV (AOR 2.86, 95% CI 1.06-7.70, p<0.001), and increasing HBVc knowledge (AOR 2.68, 95% CI 1.83-3.92, p<0.001) were independent predictors of full-dose HBVc in FRSC members, Kaduna Sector Command. Conclusions: HBVc coverage and knowledge are poor among FRSC members, Kaduna Sector Command. Educational intervention, geared towards improving FRSC members’ knowledge of HBVc and perception of risk of occupational exposure to HBV, is recommended for these vulnerable public safety workers. Such enlightenment could be a cheap and easy way of improving HBVc coverage in the study population.