Health Systems Research

Stimulant consumption in high-risk occupations temporarily enhances alertness and productivity while producing cumulative physiological and cognitive harms that increase accident risk. This paper integrates structured field observations from construction sites with mechanistic neurochemical and physiological analysis to examine dizziness, loss of coordination, cognitive fatigue, and safety outcomes. Users are classified as heavy users, recreational users, and avoiders. Findings demonstrate a transient performance boost followed by sleep disruption, autonomic strain, dehydration-related balance impairment, receptor desensitization, and elevated propensity for risky decisions. Recommendations address workplace education, monitoring, health support, shift design, and policy measures to reduce harm and improve safety.

Postnatal care (PNC) services are essential for reducing maternal and neonatal morbidity and mortality. Despite this importance, PNC uptake remains low in many parts of sub-Saharan Africa, including Kenya. Community-level factors such as socioeconomic, geographical, cultural, and health system determinants may strongly shape utilization patterns. This study assessed the influence of community factors on the utilization of PNC services in Samburu North Sub-County, Samburu County, with a focus on socioeconomic, geographical, cultural, and health system determinants. A cross-sectional study was conducted among 384 women of reproductive age who had delivered within the last two years. Data was collected using a structured intervieweradministered questionnaire, complemented by hospital record reviews. The tool captured sociodemographic details, community-level determinants, and PNC attendance. Data was analyzed using descriptive statistics, Chi-square tests, and multivariate logistic regression, with significance set at p < 0.05. Overall, 46.1% of respondents utilized PNC services, while 53.9% did not. Socioeconomic factors significantly associated with PNC uptake included education level (p = 0.008), employment status (p < 0.001), household income (p < 0.001), decision-making autonomy (p < 0.001), and savings group membership (p < 0.001). Geographical factors also influenced utilization: women living more than 10 km from a health facility were less likely to use PNC (p < 0.001), while access to good roads (p < 0.001) and affordable transport (p < 0.001) increased uptake. Health system factors such as emergency access (p = 0.006), responsive care (p < 0.001), and receiving PNC information during ANC (p = 0.002) were also strong predictors. In the multivariate model, the strongest independent predictors included employment (OR = 11.17, p < 0.001), savings group membership (OR = 7.24, p < 0.001), good road infrastructure (OR = 8.63, p < 0.001), family support (OR = 7.48, p < 0.001), and health awareness during ANC (OR = 8.99, p < 0.001). PNC utilization in Samburu North Sub-County is suboptimal, with less than half of mothers accessing services. Utilization is shaped by a combination of socioeconomic empowerment, infrastructural accessibility, household support, and health system responsiveness. Strengthening women's economic empowerment, improving transport and road networks, promoting savings groups, and enhancing respectful and informative care during ANC may significantly improve PNC uptake.

There is a need for research to understand and improve health systems for rare diseases in order to ensure that new, efficacious therapies developed through basic and early translational science lead to real benefits for patients. Such research must (i) focus on appropriate patient-oriented outcomes, (ii) include robust study designs that can accommodate real-world decision priorities, and (iii) involve effective stakeholder-engagement strategies. For transformative therapies, study outcomes will need to shift toward longer-term goals in recognition of success in preventing catastrophic outcomes. For incremental therapies, outcomes should be selected in recognition of the impact of care on quality of life for patients and families. To generate new evidence, we suggest that hybrid study designs integrating elements of practice-based observational research and pragmatic trials hold the most promise for addressing priorities such as minimizing bias, accounting for cointerventions, iden...

Sub-Saharan Africa (SSA) accounts for about 70% of the global burden of cervical cancer; this is due to several factors including lack of access to cervical cancer screening, low knowledge of cervical cancer and screening services, poor-functioning health systems, insufficient and poorly trained health workers, and the high burden of human immunodefiency virus (HIV) infection. To date, to the best of our knowledge, there has been no systematic review of the literature on the role of community-based resources such as community health workers and community-based organisations in increasing the uptake and or continuing participation of women in cervical cancer screening, in the setting of high HIV burden, in sub-Saharan Africa. We will systematically search selected databases and websites from 1980 to date for published and grey literature including citation and reference list tracking, on studies with a community focus carried out in sub-Saharan Africa, without language restrictions. Randomised controlled trials (RCTs), observational studies, and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting impact on participation in cervical cancer screening in sub-Saharan Africa will be identified and assessed for methodological quality by two independent reviewers. We will use narrative synthesis and/or meta-analysis depending on the study selection. Findings will be summarised into abstracts for presentation at conferences and submission to peer-reviewed journals in the field for wide-ranging dissemination to patients, researchers, healthcare professionals and policy makers on cervical cancer in sub-Saharan Africa. The review will address the gap in evidence for effective and implementable community-based strategies that encourages uptake of cervical cancer screening among women living in sub-Saharan Africa. The findings will have the potential to inform future screening practice and research with the hope of reducing the burden of cervical cancer in the region. registration number -CRD42018102539. Cervical cancer (CC) is a preventable public health problem that affects women worldwide. The highest burden of the disease is found in Sub-Saharan Africa. 1 In this study, we refer to SSA as a region in Africa that includes 48 countries according to the World Bank classification. 2 According to the latest 2018 Globocan estimates for cervical cancer rates, Swaziland has the highest age standardised incidence rates of about 75 per 100,000 women per year while Malawi have the highest age standardised mortality of about 54 per 100,000 women per year in the world respectively. 1 The high mortality and morbidity of CC in SSA can be attributed to the lack of national cancer prevention programmes and limited resource allocation to the prevention and treatment of CC precancerous lesions. 3 Overall, the main risk

Introduction
Traditional medicine (TM), refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to the different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness. Medication use in pregnancy is a public health concern because of the potential adverse consequences on the mother and developing foetus. The use of traditional medicines among
pregnant women in Nigeria has not been widely studied, hence, this study aims to bring to light
the patterns of use, knowledge base and determinants of the uptake of traditional medicines among pregnant women attending Asokoro District Hospital.

Objectives
The study aimed to assess the uptake of traditional medicine among pregnant women attending antenatal clinic in Asokoro District Hospital, FCT, Nigeria.

Materials and Method

A cross-sectional quantitative study was conducted at Asokoro District Hospital, to assess the uptake of traditional medicine among pregnant women attending secondary health care facilities in the FCT using an interview-administered questionnaire filled by 328 women and analyzed with SPSS version 29.0.0.0.

Results
40.2% of the sample population used traditional medicine during pregnancy with herbal
medicines being the most commonly used; ginger and garlic were the most commonly used,
with 38.4% and 35.7% of respondents using them. Morning sickness and bitter taste in mouth
were the most common illness treated using traditional medicine during pregnancy. Observations suggest that educational level, age, marital status, employment status, income
bracket and ethnicity were determinant factors of herbal medicine utilization among pregnant mothers.

Recommendations
To ensure the safe use of traditional medicine during pregnancy, the study suggests educating
pregnant women in antenatal clinics about traditional remedies, integrating traditional and
conventional healthcare, regulating traditional medicine practices, improving communication
between healthcare providers and patients, and conducting further research. Civil society
should promote safe practices and discourage self-medication, while health authorities should
offer clear guidelines on managing adverse effects and recognizing serious side effects.

Ethical dilemmas frequently arise in the treatment of clients with eating disorders, and clinicians regularly encounter an array of ethical challenges related to whether or not overt and covert coercive tactics should be implemented. In this paper, the authors provide an overview of perplexing ethical questions relevant to medical, nutritional and psychological treatment of clients with eating disorders including imposed treatment, enforced feeding, the duty to protect minors and adults, the determination of competence and capacity among medically comprised clients, and the effectiveness of coercive treatment for clients with eating disorders. The processes of ethical decision‐making in terms of ethical principles, professional codes of conduct, the existing empirical literature and the use of a decision‐making framework are explored. Taking a collaborative and client‐sensitive approach, the authors outline and apply an integrative ethical decision‐making model to facilitate clinici...

The 2014 Ebola Virus disease outbreak and the COVID-19 pandemic are prominent among the viral infectious diseases that threatened our existence in the last decade. We did a retrospective review of Nigeria's responses during the two crises using different keywords: pathogenicity, risk communication, data gathering, and vaccine issues. These served as discussion points, and we ended by highlighting a few salient observations that should serve as reflection, learning points, and recommendations for better responses in the future. Based on these keywords, we noticed some differences in the two outbreaks, some of which affected the mode of response. At some point, Nigeria was commended for curtailing the Ebola outbreak. This was not the same with COVID-19 which is still very much with us. Also, the latter received more global attention. We then concluded the review by outlining salient points that should serve as reflection and learning points to serve as a guide for a better approach in future epidemics/disaster outbreaks.

Background: Health system reform initiatives have increasingly embraced decentralization as a key trend. The implementation process and its outcomes are influenced by a myriad of factors, including economic forces, political dynamics, and ideological factors. Comprehending and carefully examining the implementation phase of decentralization and its consequences to achieve desired outcomes is crucial. Notably, this phase is often considered the weakest aspect of policy reforms, especially in developing countries. Therefore, this study aimed to explore and analyze the implementation phase of decentralization and its implications as essentials for achieving intended goals. The study objectives evolved around examining the entire decentralization as a multifaceted social and political process in Khartoum State, Sudan, from its early stages of decisionmaking, policy formulation, and implementation process and the influencing contextual factors. Methods: This study was an exploratory qualitative study that employed in-depth interviews to gather perspectives of healthcare providers and policymakers, semi-structured observations, and thematic analysis. The study utilized Grindle's framework for analysis. Findings: This study revealed a political nature of decision-making, with a top-down approach to the implementation, which also lacked stakeholder involvement. It showed a lack of transparency, official documentation, and proper handover procedures from the Ministry of Health to the devolved hospitals during the implementation process. A conflict of interest between the federal and the state level was also reported. It is important to note that this process occurred within the context of structural adjustment program (SAP) schemes, which had already empowered the private sector in Sudan. Conclusion: This study documented the implementation process of decentralization of health services and its influencing factors. The study recommended reforming the decentralization policy through consultative stakeholder involvement and by implementing a concurrent responsibility paradigm that divides authority between the federal and state levels. KEYWORDS decentralization, process of implementation, health system, governance of health services, stakeholder involvement, conflict of interest

Background & objectives
India has the second highest number of adults with diabetes in the world, and more than one-fourth of adults have hypertension. This article describes the preparedness of public and private health facilities for type 2 diabetes mellitus and hypertension management.

Methods
A cross-sectional survey of the health facilities was conducted in 19 districts of seven States in India, which included an assessment of both public and private health facilities. We used the Indian Public Health Standards and other relevant guidelines for assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity, staff, including the availability of guidelines, and overall readiness score, was calculated following the Service Availability and Readiness Assessment manual of the World Health Organisation. The study considered a readiness score of ≥70 per cent to classify a facility as prepared for providing hypertension and diabetes services.

Results
Out of 415 health facilities covered in the survey, 75.7 per cent were public facilities. Most were primary care facilities (57.6%) and were located in rural areas (53.3%). The overall readiness score for providing hypertension and diabetes services was lowest for Sub-Centres (SCs; 61%) and Community Health Centres (CHCs; 59%), compared to other facilities. The readiness score for public Primary Health Centres (PHCs) and private primary care facilities (level 2) was 73 and 57 per cent, respectively. The readiness score of district hospitals, government private medical colleges, and other private tertiary care facilities was above 70 per cent, and they were considered prepared for services.

Interpretations & conclusions
PHCs were better prepared for diabetes and hypertension care than SCs, CHCs, and SDHs. By ensuring adequate human resources availability and uninterrupted supply of essential medicines, programme managers can further improve the preparedness of all public health facilities.

É na unidade de relação do usuário com os serviços que devem ser centradas as analises que busquem conhecer como o direito à saúde se expressa concretamente no cotidiano das pessoas. A categoria central para analise dessas inter-relações é o acesso. «Access is the actual use of personal health services and everything that facilitates or impedes that use. It is the link between health services systems and the populations they serve. The conceptualization and measurement of access is key to the understanding and formulating of health policy because they can be used to understand health services use and to promote the equity, effectiveness, and efficiency of that use». Resumen: Este trabajo tiene como objeto la revisión de una categoría hartamente utilizada en el campo de la salud como lo es la accesibilidad a la atención en salud. Se presentan las principales caracterizaciones y definiciones de la categoría de accesibilidad -o acceso -a la atención en salud que han circulado en el ámbito de la Salud Pública, para luego presentar de la forma en la que define la accesibilidad, sus dimensiones y alcances en la investigación que dio origen a este trabajo. El análisis de la accesibilidad se centra en la relación entre usuarios y servicios. Se considera a la accesibilidad como un analizador que permite conocer la forma en la que las personas se relacionan con el sistema de salud. La accesibilidad a la atención en salud como analizador echa luz sobre categorías tales como procesos de estigmatización, políticas de salud y salud mental, derecho a la salud, prácticas en salud y subjetividad. Se tomaron para la operacionalización de la categoría de accesibilidad cuatro dimensiones: la dimensión económica, la dimensión técnica, la dimensión política, la dimensión simbólica.

Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities - in terms of context, contents, actors, and processes. Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n=11), and stakeholder analysis/position-mapping. In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politi...

A new milestone in India's sustainable development journey is the localisation of Sustainable Development Goals at district level in the Northeastern states and subsequent release of the NER District SDG Index Report 2021-22. The article attempts to make a critical appraisal of this report along with the localisation initiative. Despite of the innovative venture, this initiative faces certain challenges and gaps leaving behind rooms for further improvement.

The pattern of craniomaxillofacial fractures seen in children and adolescents varies with evolving skeletal anatomy and socioenvironmental factors. The general principles of treating mandibular fractures are the same in children and adults: Anatomic reduction is combined with stabilization adequate to maintain it until bone union has occurred. But recognition of some of the differences between children and their adult counterparts is important in long-term esthetic and functional facial rehabilitation as effect of injury, treatment provided has a great influence on their ensuing growth.

In recent times, the showcasing of professional ethical standards at workplaces has become an imperative issue of interest in almost all professions including the health profession in general and nursing. This study investigated patient's knowledge and perception of patients on Nurses' adherence to their professional codes of ethics in Ghana, using Eastern Regional Hospital, Koforidua as a case study. A Cross-sectional survey was conducted among 400 patients at the Eastern Regional Hospital, Koforidua using a simple random sampling in selecting participants. A structured questionnaire was used to collect data from the participants. Females (64.8%) dominated the study and a Majority (68.5%) of respondents were between the ages of 21-40 years. Most of the respondents (83.2%) did not have any knowledge about nurses' professional code of ethics. The majority (59.8%) of patients agreed nurses do not introduce themselves with their name, title and professional role to patients. However, most of the respondents (60.3%) agreed that nurses carried out all nursing interventions and procedures with respect to preserving the patient's dignity. The respondents indicated that majority of nurses (78.5%) did not discriminate in attending to patients. Most nurses (66.0%) obtained the consent of the patient before any nursing intervention is performed. Majority of patients (83.3%) do not have knowledge of the nurses' professional code of ethics in Ghana. Ghanaians need to be sensitized on professional ethics of nurse to understand and know what is expected of nurses so they can be able to put nurses in check.

Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country’s epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.

El Decreto de Necesidad y Urgencia (DNU) N° 70/2023, titulado "Bases para la Reconstrucción de la Economía Argentina", introduce profundas reformas en el sistema sanitario que podrían vulnerar las garantías del derecho a la salud. Este artículo analiza las medidas incluidas en el Título XI – Salud, con especial énfasis en la desregulación de la medicina prepaga, la eliminación de la Agencia Nacional de Laboratorios Públicos (ANLAP) y la flexibilización de las obras sociales. A partir de un enfoque constitucional e internacional, se examina cómo estas modificaciones afectan las obligaciones estatales de garantizar el acceso equitativo a la salud, en contraposición al principio de no regresividad en materia de derechos sociales. El estudio concluye que las reformas planteadas, bajo el argumento de la eficiencia económica, representan un retroceso significativo en la protección del derecho a la salud, especialmente para los sectores más vulnerables de la población.

OBjECTIvES: Residency training is important worldwide and recent studies have put more emphasis on its quality evaluation. This study aims to first explore the impact of educational backgrounds on the quality of gynecology and obstetrics (OB-GYN) standardized resident training (SRT) program in China, which may provide crucial evidence for policy considerations to improve SRT quality. METhOdS: A total of 397 OB-GYN resident graduates were enrolled in this retrospective cohort study. They were divided into three groups according to their educational background, that is Bachelor of Medicine (BM), Master of Medicine (MM), and Doctor of Medicine (DM) groups. The characteristics and the results of SRT graduation examination and annual assessment of these residents were collected and compared using one-way analysis of variance or Pearson's chi-square test. A multivariable logistic regression analysis was performed to identify the association between sociodemographic variables and pass rates of SRT graduation examination. Besides, a subgroup analysis on training time for the DM group was performed. Strobe protocol was followed. RESulTS: The residents were older in DM group than that in BM and MM groups (P < 0.001). There was significant difference of the training length and the proportion taking part in SRT graduation examination among three groups (P < 0.001). Although the written test scores of SRT graduation examination were the lowest in BM group (P = 0.015), there was no significant difference in other results among three groups. No significant variable was found associated with the pass rates of SRT examination. No significant difference was found in the subgroup analysis of DM group. COnCluSIOn: Overall, the SRT quality of OB-GYN residents with different educational backgrounds was good and comparable. However, residents with BM degrees had lowest written scores and need to be strengthened during training. The training time of residents with DM degrees can be shortened according to their own conditions.

Gender-the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders-affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. We outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes Starting with HSR content, i.e. the substantive focus of HSR, we recommend exploring whether and how gender power relations affect females and males in health systems through the use of sex disaggregated data, gender frameworks and questions. Sex disaggregation flags female-male differences or similarities that warrant further analysis; and further analysis is guided by gender frameworks...

To my parents, Mike and Tracey Johnson, who always pushed me to excel personally and professionally so that I had opportunities of which I never could have dreamt. To my fiancé and best friend, Brenden O'Leary, who has been a fount of encouragement and love throughout this process. Here's to the beginning of yet another adventure! ACKNOWLEDGMENTS I could not have made it this far without the support and encouragement of mentors, colleagues, and co-workers. While I have thought multiple times throughout my academic career that I would quit school and be satisfied, I am happy to say that my own internal motivation, along with that of my cheerleaders, led me to continue to improve my own life and my environment. My parents taught me to ensure that I was contributing to the improvement of the world around me, Drs. Desiderio and Walker at Georgia Southern University were supportive of my research and professional development endeavors. Drs. Kelly Sullivan and Greg Danyluk were excellent mentors and representatives of the USF College of Public Health and were a large part of the reason I applied. Drs. Janice Zgibor and Ronee Wilson were invaluable in their support, problem-solving, and overall mentorship. No woman is an island, and I am eternally grateful and blessed to have had meaningful guidance throughout my academic career.

ObjectiveThe objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for Federally Qualified Health Center (FQHC) patients in Hawaiʻi, an ethnically diverse state with a high proportion of Native Hawaiians and Pacific Islanders (NHPI).Research design and methodsWe used a qualitative descriptive approach. First, we conducted a document review of existing programmatic notes and materials followed by video interview calls with 13 lifestyle coaches at 7 FQHCs implementing in-person LCPs. Lifestyle coaches catalogued, described and explained the rationale for adaptations. The research team counted adaptations if they met a specific adaptation definition derived from several sources. Community and cultural relevancy of adaptations were analysed using an existing framework for weight loss and diabetes prevention for NHPIs.Res...

A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system. We put forth the ''2020 Vision for a High-Quality, High-Value Maternity Care System'' to serve as a positive starting place for a fruitful collaborative process to develop specific action steps for broad-based maternity care system improvement.

Background: This study presents the various variables of the first cluster of COVID-19 was identified in the Union Territory of Dadra and Nagar Haveli and Daman and Diu, India. Methods: The investigation design combined active case findings, contact tracing, and containment policy around each confirmed case. The various epidemiological parameters were counted with the verbal autopsy of confirmed cases and possible contacts. Results: It was a small-scale cluster that started with an imported case. In this cluster, a total of 18 infected persons, 243 high-risk contact, and 105 low-risk contacts were identified. The entire positives were linked to each other within a single chain of transmission, therefore; Airborne, droplet, and hand-to-hand transmissions were suspected.Conclusions: The results of the present study were suggested that early detection, active surveillance, testing of suspected cases, isolation of cases, quarantine of contacts are the key objectives to contain the COVID...

The 2014 Ebola Virus disease outbreak and the COVID-19 pandemic are prominent among the viral infectious diseases that threatened our existence in the last decade. We did a retrospective review of Nigeria's responses during the two crises using different keywords: pathogenicity, risk communication, data gathering, and vaccine issues. These served as discussion points, and we ended by highlighting a few salient observations that should serve as reflection, learning points, and recommendations for better responses in the future. Based on these keywords, we noticed some differences in the two outbreaks, some of which affected the mode of response. At some point, Nigeria was commended for curtailing the Ebola outbreak. This was not the same with COVID-19 which is still very much with us. Also, the latter received more global attention. We then concluded the review by outlining salient points that should serve as reflection and learning points to serve as a guide for a better approach in future epidemics/disaster outbreaks.

Paraphrasing from common parlance, “a virus’ name precedes it”. Due to the name of its causative organism; most would consider COVID-19 as a primarily respiratory illness. This is substantiated by the readily obvious respiratory symptoms and the popular use of facemasks as a means of prevention. COVID– 19 presents as a respiratory disease with a multi-systemic representation, multisectorial importance and a  multidimensional impact on humanity.
This chapter brings to bear, the public health manifestations of COVID-19
providing an overview of the anthropologic, epidemiologic, Global Health, etiologic, pathogenetic, diagnostic and health system concerns and perspectives since the virus was discovered in the last days of 2019.

Keywords: COVID-19; health systems; public health; anthropology;
epidemiology; determinants.

The 2014 Ebola Virus disease outbreak and the COVID-19 pandemic are prominent among the viral
infectious diseases that threatened our existence in the last decade. We did a retrospective review of
Nigeria’s responses during the two crises using different keywords: pathogenicity, risk communication, data
gathering, and vaccine issues. These served as discussion points, and we ended by highlighting a few salient
observations that should serve as reflection, learning points, and recommendations for better responses in
the future. Based on these keywords, we noticed some differences in the two outbreaks, some of which
affected the mode of response. At some point, Nigeria was commended for curtailing the Ebola outbreak.
This was not the same with COVID-19 which is still very much with us. Also, the latter received more global
attention. We then concluded the review by outlining salient points that should serve as reflection and
learning points to serve as a guide for a better approach in future epidemics/disaster outbreaks.

A growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low-and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind.

Background: Children's health is very important for their better learning and timely nourishment everywhere in
the world. Malnutrition among school going children has remained a big challenge in under developed
countries.
Methods: Cross-sectional study was conducted among 422 children of four Government Primary schools of
Qasimabad, district Hyderabad after taking the proper consent and administration approval from the head of
school. Multi stage simple random sampling technique was adopted. Study was approved from Institutional
review board of Health Services Academy Islamabad.
Results: Out of total, 217 (51.4%) were boys and 205 (48.6%) were girls. Mean Height of boys and girls were
128.09 cm (±SD 12.90) and 130.36 cm (±SD 12.50) respectively. Mean Weight of boys was 25.27 Kgs (±SD
6.17) while in girls mean Weight was 26.83 Kgs (±SD 7.03). 17.57 cm (±SD 2.34) was mean MUAC for all
participants and mean BMI was 15.42 (±SD 2.02). Prevalent of stunting and wasting were 24.4% and 18.3%
respectively. While in 13.7% thinness (BMI for age) was seen. Stunting was statistically significant in girls 9-10
year (p value=.015, CI: .118-.823, OR=.311) and 11-≥12 years (p value=.018, CI: .215-.874, OR=.434). Pallor
was more in girls (17%) and Dental caries were higher in boys (20.8%). Insufficient breakfast was done by 347
(82.2%), whereas 75 (17.8%) were doing sufficient breakfast. 341 (80.8%) students became ill during last year,
out of that 80 (19%) were having history of hospitalization.
Conclusion: Poor polices and lack of food aid interventions regarding health of primary school going children
was assessed during this study.
Key Words:Stunting, wasting, thinness, children, government primary schools

Background: Menstruation is a major stage of puberty in girls, one of the many physical signs that a girl is
turning into a woman. Women having better knowledge about menstrual hygiene and safe practices are less
vulnerable to RTI and its consequences. Therefore, increased knowledge about menstruation right from
childhood may escalate practices and may help in mitigating the suffering of millions of women. This study
carried out to gather information regarding menstruation, hygiene related practices and its related problems
among adolescent girls along with to review perceptions, belief and expectations regarding menstruation
among adolescent girls.
Methods: A Cross-sectional study was conducted,314 girls of 12 to 15 years were identified as sample from 5
girls high schools. Pre tested pre designed questionnaire was used. Data were analyzed by using SPSS
(Version 22). Descriptive statistics used to determine mean age of the subjects, age at menarche, frequency of
menstrual disorders and activities affected by this condition.
Results: Mean age of the sample was 14.25 years, with mean age of menarche 12.6 years. 52.6% of the girls
belong to the mothers who are illiterate. 50.7% girls were aware of menstruation before menarche with major
source of the information is mother (71.2%). 97.8% perceived menstruation as a normal process. 55.1%
participants said they missed their school during menstruation. 96.4% experiencing pain and cloth was most
common source of absorbent used by 60.2%.
Conclusion: Mothers are the main source of information for young girls. Major reason for absenteeism from
school was fear of stain, it has been suggested through cleanliness available for changing absorbent
(pad/cloth) the ratio of absenteeism can be reduce.
Keywords: menstruation, hygiene, puberty, perception

According to the World Health Organization, the efficacy of infection prevention and control protocols, as well as the provision of superior quality healthcare, is contingent upon health facilities adhering to appropriate sanitation standards and reducing the risk of pathogen exposure for both patients and healthcare workers. Infections that may lead to adverse pregnancy outcomes, sepsis, or even mortality among pregnant women and their neonates necessitate particular vigilance to avert. Throughout each phase of the sanitation service continuum-ranging from the provision of safe toilets and proper containment to the transportation, treatment, and ultimate disposal or intended use of waste-a comprehensive sanitation system is designed and executed to ensure the segregation of human excreta from human interaction. When sanitation safety is strategically planned, it facilitates the implementation of a holistic approach to address faecal management issues, encompassing everything from toilets to secure disposal or utilization. Healthcare-associated infections (HAIs) impact hundreds of millions of individuals globally on an annual basis. Despite being recognized as the most prevalent adverse occurrence in healthcare settings, the comprehensive global ramifications of HAIs remain ambiguous due to the difficulties inherent in acquiring reliable data. A principal objective of the WHO's Infection Prevention and Control (IPC) team is to understand and assess the worldwide prevalence and impact of HAIs. This study endeavours to evaluate the degree of implementation of Sanitation and Hygiene practices within sub-district hospitals in the Gadag district and to ascertain opportunities for enhancement. Objectives: To assess the level of implementation of sanitation and hygiene guidelines in sub-district hospitals in Gadag District. Methods: A cross-sectional study was conducted in sub-district hospitals in Gadag district, and an universal sampling technique was used to choose the health centers. A kayakalp checklist 2021 was used to obtain the data from December 2023 to January 2024. Data were entered into Microsoft Excel, and results were expressed in frequency and percentages. Results: Total 4 sub-district hospitals were visited; the total score was 100 in that Mundaragi Sub-district hospital has 65/100 (65%), Shirahatti Sub-district hospital 67/100 (67%), Rona 70/100 (70%), and Naragund 63/100 (63%). Conclusion: The findings from the different sub-district hospitals show differences in how sanitation and hygiene regulations are applied. While some hospitals adhere to cleaning guidelines in important areas with great diligence, others need major improvements, especially when it comes to the cleanliness of auxiliary areas, restrooms, and the oversight of cleaning activities.

This study aims to investigate and describe socio-economic correlates of malnutrition among the children enrolled in the government schools of District Multan and to determine the extent of the association of school facility and or access to health care services. The research followed a quantitative research design with the subjects consisting of 252 students aged 12 to 15 years obtained from five randomly selected government schools. Data was collected through structured questionnaires while the determinants of malnutrition were analyzed using SPSS package. From the study it was noted that poverty, parental education and awareness have a higher relationship with malnutrition. A large number of learners had poor knowledge on the balanced diet and there was variation in gender with regard to malnutrition related prejudices. Results of the statistical analysis showed that various demographic and socioeconomic factors affected the nutritional status of the population, and poor people with low education standards had a poorer status. It also emphasizes intervention that focus on socio-economic factors, education and nutrition and gender aspects when addressing the issue of malnutrition among schoolchildren. Key words: Malnutrition, Poor Diet, Dietary Behavior, Balanced Diet, Health and Nutrition

Background: Maintaining cleanliness and hygiene holds great importance within healthcare environments. The Swachh Bharat Abhiyaan represents a nationwide initiative launched by the Indian government with the aim of fostering cleanliness in communal areas. The 'KAYAKALP' scheme serves as an effort to advance cleanliness standards and bolster the caliber of public healthcare facilities. Furthermore, the Ministry of Health and Family Welfare of the Government of India has initiated a National Program aimed at recognizing public health facilities that demonstrate high standards of hygienic practices, infection control, and overall cleanliness. This research aims to assess the extent of implementation of the Kayakalp initiative in Community Health Centers and Sub-District Hospitals within the Gadag District. Objectives: To assess the level of implementation of Kayakalp guidelines at Community Health Centres and Sub district hospitals of Gadag District. Methods: A hospital based cross-sectional study was conducted in Sub district hospitals in Gadag district and universal sampling technique was used to choose the health centres. A kayakalp checklist 2021 was used to obtain the data from December 2023 to January 2024. Data were entered into Microsoft excel and Results were expressed in frequency and percentages. Results: In the current study Ron Sub district hospital scores 523/700 (74.71%), Shirahatti Sub district hospital scores 380/700 (54.28%), Nargund Sub district hospital scores 410/700(58.57%), Mundargi Sub district hospital scores 404/700 (57.71%), Lakshmeshwar Community Health Centre scores 367/700 (52.42%), Gajendragad Community Health Centre Scores 371/700 (53%). Conclusion: The present study was an attempt to assess the level of implementation of Kayakalp guidelines in Sub district hospitals and Community health centres in Gadag district. The findings from this study reveals that 3 sub district hospitals have poor implementation of the Kayakalp guidelines in their centre and 1 sub district hospital has better performance.

To assess the quality of private pharmacy practice with a focus on the extent of antibiotic sales without prescription in private pharmacies in four Zimbabwean cities in relation to two tracer infectious conditions-sexually transmitted infections (STIs) among females and males, and diarrhoea in a child. Methods: A cross-sectional study including pharmacies in Harare and three other towns. Information about each pharmacy was collected through structured interviews. Staff were interviewed using a different structured interview guide and simulated clients were used to assess staff performance. Data were analysed statistically, and step models to evaluate pharmacist performance were developed. Results: A majority (69%) stated that they would never sell an antibiotic without a prescription and very few actually did in spite of a high patient demand. Few respondents however performed acceptably regarding provision of information and advice in relation to guidelines: 8% for the STI male, 33% for the STI female and 22% for the diarrhoea scenario. The study revealed low sales of antibiotics without prescription, showing good adherence to the letter of the law. However, few respondents performed acceptably in relation to guidelines when considering information and advice for the tracer conditions.

Background: Problems related to cold chain functioning & vaccine handling have been reported from developed & developing countries. Such studies help programme officers & policy makers. So this study was undertaken.

Objectives: The study was conducted with an objective to know the Cold Chain Maintenance & vaccine administration practices in government, private hospitals & clinics of Mangalore city.

Material & Methods: This health systems research was conducted in Mangalore City. List of government, private hospitals & private clinics were obtained from District Health Office and Indian Medical Association local chapter. A Pre-Tested semi-structured proforma was used to collect information to meet the objective. After obtaining consent from necessary authorities, these hospitals were visited and observations noted directly in the proforma. Photos were taken if permitted in the hospitals. The quality of vaccine administration practices were graded (1 to 5) and scored (from 20 to 100).

Results: Comparison of government (n=8) & private hospitals (n=8) revealed that the cold chain maintenance system was better in the government hospitals. Vaccine administration practices were better in private hospitals. Various incorrect practices in cold chain maintenance and vaccine administration practices were noted in both government and private hospitals.

Conclusions: Training in & periodic supervision of cold chain maintenance and vaccine administration practices are essential for achieving the benefits of vaccination.

Aim A populations' perception of health service delivery is critical to the understanding of the relationship between quality of care and utilization of health services and has been increasingly treated as an outcome of health care delivery. This study aimed to assess the perceived impact of a basic package of health services on health service delivery and mortality in Wulu County, South Sudan. Methods A cross-sectional survey of 396 eligible adults aged 18 years and above who had benefitted from the services of health facilities within communities of Wulu County and equally resided in the community during the years 2014 to 2016 was conducted. A structured questionnaire was used to determine respondents' perceived mortality and health service delivery ratings. Results Most respondents expressed moderate overall perceptions of health service delivery (62.4%) and mortality (84.1%) during 2014-2016. In 2016 significantly lower (p < 0.05) mortality perception scores and significantly higher perceived scores of health service delivery were recorded than in 2014 and 2015. In 2015, however, significantly lower mortality perception scores were recorded than in 2014. Respondents from the most urban area, Wulu Payam, expressed significantly higher health service satisfaction scores than those from other payams. Conclusions The perception of a basic package of health services provided by health care agencies in South Sudan as expressed by the residents of Wulu County was satisfactory and considered to have achieved a significant reduction in the population's mortality rate. However, the rural payams appeared to be lagging behind.

More than 1 in 3 adults in the United States is at risk for developing type 2 diabetes. 1 The National Diabetes Prevention Program (National DPP) provides a framework for type 2 diabetes prevention efforts that includes an evidence-based lifestyle change program (LCP). However, the program is underused because of a lack of access, despite its proven value and cost effectiveness. 2 Telehealth holds promise for increasing access to and engaging individuals in National DPP LCP. Telehealth offers people access to affordable health care by using technology such as a computer or smart phone. Technologies used to deliver type 2 diabetes prevention in underserved areas include phones, smartphone apps, computers, texts, and videos. Each can be used, together with live interaction with a trained lifestyle coach, to deliver the National DPP LCP virtually. HabitNu achieved success using telehealth by streamlining processes to engage and connect participants and create partnerships to increase access to services.

While the combination of nifurtimox and eflornithine (NECT) is currently recommended for the treatment of the late stage human African trypansomiasis (HAT), single-agent eflornithine was still the treatment of choice when this trial commenced. This study intended to provide supportive evidence to complement previous trials. A multi-centre randomised, open-label, non-inferiority trial was carried out in the Trypanosoma brucei gambiense endemic districts of North-Western Uganda to compare the efficacy and safety of NECT (200 mg/kg eflornithine infusions every 12 h for 7 days and 8 hourly oral nifurtimox at 5 mg/kg for 10 days) to the standard eflornithine regimen (6 hourly at 100 mg/kg for 14 days). The primary endpoint was the cure rate, determined as the proportion of patients alive and without laboratory signs of infection at 18 months post-treatment, with no demonstrated trypanosomes in the cerebrospinal fluid (CSF), blood or lymph node aspirates, and CSF white blood cell count &l...

Nigeria is a high tuberculosis (TB) burden country. However, there is limited evidence on implementation of tuberculous infection prevention and control (TBIC) practices in Nigeria. O B J E C T I V E : To assess TBIC practices, and barriers to their implementation, in TB-DOTS centres in Lagos State, Nigeria. D E S I G N : A descriptive cross-sectional study was used to assess 112 TB-DOTS centres in primary and secondary health facilities in Lagos State using mixed methods. Quantitative data comprised a survey and measurement of the air exchange rate in a subsample of centres. The qualitative aspect comprised focus-group discussions to highlight health care workers' (HCWs') perceptions of TBIC guidelines and barriers to their implementation. R E S U LT S : The majority of the DOTS centres had a dedicated TBIC officer, while a fifth (21%) had

Background Various countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia. Methods A community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data a...

Background Various countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia. Methods A community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data a...

Rekha Raghunathan, IIHS Word Lab b. Translation: Where a translation of this work has been created by a third party, prior written permission must be obtained from IIHS. Attribution to IIHS shall be accompanied by the following disclaimer: ''All rights in relation to the material contained in the original work vest with the Indian Institute for Human Settlements (IIHS)." c. Adaptation: Where an adaptation of the original work has been created, prior written permission must be obtained from IIHS. Attribution to IIHS shall be accompanied by the following disclaimer: '' All rights in relation to the material contained in the original work vest with the Indian Institute for Human Settlements (IIHS). This work is an adaptation of the original work created by IIHS. IIHS does not endorse the modified content or views/opinions contained in this adaptation in any manner.'' d. Third Party Content: This work contains third party owned material which has been duly attributed by IIHS. It is the responsibility of the user to determine the requirements for permission and obtain such permission from the respective copyright owner(s) in the event of use/reuse of third party owned material that constitutes a component of this work. Examples of components may include, but are not limited to, tables or figures. IIHS shall not be liable for any claims arising out of the infringement of material owned by a third party as a result of use/reuse by a user.

Background There is considerable optimism in mHealth's potential to overcome health system deficiencies, yet gender inequalities can weaken attempts to scale-up mHealth initiatives. We report on the gendered experiences of an mHealth intervention, in Southern Ethiopia, realised by the all-female cadre of Health Extension Workers (HEWs). Methodology Following the introduction of the mHealth intervention, in-depth interviews (n = 19) and focus group discussions (n = 8) with HEWs, supervisors and community leaders were undertaken to understand whether technology acted as an empowering tool for HEWs. Data was analysed iteratively using thematic analysis informed by a socio-ecological model, then assessed against the World Health Organisation's gender responsive assessment scale. Results HEWs reported experiencing: improved status after the intervention; respect from community members and were smartphone gatekeepers in their households. HEWs working alone at health posts felt smartphones provided additional support. Conversely, smartphones introduced new power dynamics between HEWs, impacting the distribution of labour. There were also negative cost implications for the HEWs, which warrant further exploration. Conclusion MHealth has the potential to improve community health service delivery and the experiences of HEWs who deliver it. The introduction of this technology requires exploration to ensure that new gender and power relations transform, rather than disadvantage, women.

This study aims to rank policy concerns and policy-related research issues in order to identify policy and research gaps on access to medicines (ATM) in low- and middle-income countries in Latin America and the Caribbean (LAC), as perceived by policy makers, researchers, NGO and international organization representatives, as part of a global prioritization exercise. Data collection, conducted between January and May 2011, involved face-to-face interviews in El Salvador, Colombia, Dominican Republic, and Suriname, and an e-mail survey with key-stakeholders. Respondents were asked to choose the five most relevant criteria for research prioritization and to score policy/research items according to the degree to which they represented current policies, desired policies, current research topics, and/or desired research topics. Mean scores and summary rankings were obtained. Linear regressions were performed to contrast rankings concerning current and desired policies (policy gaps), and c...

Introduction: High quality performance and timely intervention is of utmost priority in medical emergency management. Performance management in the healthcare settings ensures that highest level performance is achieved through active management that aligns organizational activities with its set objectives and policies. Objective: To understand how and to what extent the Katsina state Hospital Services is using performance management to ensure efficiency and effectiveness in the delivery of emergency medical services to the population. Study Design: A crosssectional survey was done using quantitative methods. Paper based questionnaire was used to obtain responses from different stakeholders in emergency services delivery in order to get variety of opinions about performance management of emergency services delivery. Principal Findings: Analysis of the results have shown that the managers of Katsina state Hospital Services Management Board have knowledge about performance management h...

The article aims to explore and characterize Indian adults who seek nursing consultations. Nursing professionals constitute two-fifth of the Indian healthcare workforce, but their consultation with patients is limited. Hence investigating the profile of Indian adults who consult nurses is necessary. The study used Secondary data of 72,250 nationally representative adults from the first wave of the Longitudinal Ageing Study of India, which was analyzed for nursing consultation sought by the participants during the 12 months preceding the survey using appropriate statistical methods and weights. Out of 257.1 million adult’s ≥45 years old and their spouses, 69.3% had consulted one or more healthcare workers during the last 12 months preceding the survey, and only 1.30% of adults had consulted nurses/midwives. Those, who consulted nurses/midwives, 16.7%, 26.2%, and 13.3% had consulted at community health facilities such as sub-centers, primary-health-centers, and community-health-centre...

There is ample evidence that high neonatal and maternal mortality remain as the greatest challenges to health development in rural Africa. Moreover, clinical strategies and health modalities for addressing excess mortality are also well developed and widely disseminated. Less is known, however, about practical organizational strategies for addressing the excess perinatal mortality in rural remote localities of sub-Saharan Africa. This paper reports on a low cost, replicable, and sustainable system of risk surveillance, and action that has identified priority perinatal service problems, fostered rapid strategic planning, and catalyzed a comprehensive program of emergency management training for frontline workers, referral systems development, and quality assurance intervention at referral service points. A pilot project, regional training program, and evaluation strategy are reviewed. Interventions are focused on immediate post-delivery monitoring and referral, kangaroo mother care, ...

Background Various countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia. Methods A community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data a...

Greater medical and psychological concerns coupled with disparities in income and education and experiences with cultural distress have created an unprecedented demand for health and mental health services for Native Hawaiians. With 75% of the healthcare system moving to a value-based system within the next 2 years, a low-cost workforce that brings added value will be in high demand. The addition of community health navigators to an existing integrated patient-centered medical home may result in a culturally congruent, preventive, and responsive model of wellness that promotes health equity. The purpose of this paper is to discuss the culturally-based navigation framework we used to implement a pilot program in an integrated primary care setting, describe the intervention that was used, and examine the lessons learned throughout the process. Outcomes will be provided at a later date. We believe that our model will not only redesign an existing clinical practice but also will provide...