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Background: Developing countries’ public health systems struggle with digital health implementation, and reports of low digital health readiness exist within the workforce. This study investigates the perceived digital health readiness of healthcare leaders in operational management to implement digital health tools. Methods: A cross-sectional survey using the E-Ready 2.0 scale was used to measure digital health readiness (n = 329) in 11 hospitals in the Western Cape, South Africa (September 2023 – March 2024). Descriptive statistics summarised respondent characteristics and the E-Ready 2.0 subscales: conditions for change at the workplace and among individuals, support and engagement from management, colleagues’ readiness, consequences for the status quo and workplace attitudes. Statements scoring 60% or more were considered to have higher readiness. Chi-square and Mann–Whitney U tests were used to examine associations between demographic variables and subscale statements. Results: A total of 143 healthcare leaders responded (56.1% response rate) (n = 114 nurses [79.7%], n = 29 medical doctors [20.3%]). The average age was 46.4 ± 10.0 years. Overall, higher levels of readiness (above 70%) were observed with statements related to workplace attitudes, whereas conditions for change at the workplace and among individuals showed lower readiness (below 50%). Conclusion: Despite significant investment in digital health tools, there remains limited digital health readiness among those responsible for leading these implementations. [ABSTRACT FROM AUTHOR]

Background: Rwanda has made significant strides in malaria control. This study reviews malaria epidemiology and control strategies in Rwanda from 2018 to 2023, documenting their impact, persistent gaps and emerging challenges. Methods: Data on Rwanda's malaria context from 2018 to 2023 were obtained through a literature review of peer-reviewed articles and grey literature, including annual reports from the malaria programmes, partners, the African Union, and the World Health Organization (WHO). Specific keywords used for the search included "malaria", "Rwanda", "case management", "control", "treatment", and "prevention". Moreover, epidemiological data for this period was extracted from the Health Management Information System (HMIS). Data analysis was done using R & R-Studio, ANOVA to assess the statistical significance (P < 0.05) of observed trends and T-test to compare the focal and blanket IRS techniques. Results/Discussion: Between 2018 and 2023, all malaria indicators showed improvement. Malaria incidence dropped from 345 to 40 cases per 1000 persons (P = 0.00292), the severe malaria rate decreased from 112 to 10/100,000 persons (P = 0.018), and the mortality rate fell from 2.72 to 0.258 deaths /100,000 persons (P = 0.00617). Among children under 5 years of age, incidence decreased significantly from 331 to 52/1,000 persons (P = 0.00123), the severe malaria rate dropped from 214 to 29/100,000 persons (P = 0.00399), and mortality declined from 5 to 0.453/100,000 persons (P = 0.00504). Over the same period, key malaria interventions expanded. The proportion of cases treated by CHWs increased significantly, improving access to early diagnosis and treatment (from 13 to 59%), and the new generations of ITNs (PBO and dual-active ingredient nets) were deployed in 9 districts. Since 2019, a blanket spraying technique has been adopted in 12 IRS districts replacing the focal spraying technique contributing to the significant decrease of malaria incidence from 2019 to 2023 (P = 0.0025). However, new challenges have emerged, including the rise of the K13 R561H mutation associated with artemisinin resistance, the spread of insecticide resistance, and limited intervention coverage due to resource constraints. Conclusion: To sustain the progress achieved, it is essential to intensify malaria control efforts, foster compliance with intervention strategies, enhance surveillance systems for timely and effective responses, and secure long-term funding to sustain these measures. [ABSTRACT FROM AUTHOR]

Background: The outpatient palliative care system is a central component of the palliative care structure in Germany, with family caregivers playing a vital role in ensuring and maintaining its success. However, crisis situations can destabilise and harm outpatient care. Previous studies have analysed hospitalisations and emergency admissions during palliative care. However, little is known about the factors that contribute to the emergence of crises in palliative outpatient care. The aim of this study was to identify factors contributing to the emergence of crisis in palliative outpatient care including the identification of protective strategies. Methods: A qualitative study using semi-structured interviews with family caregivers recently involved in outpatient palliative care was performed. The analysis was conducted using thematic coding. Results: A total of 15 family caregivers (13 female and 2 male) were recruited for the study. Crisis situations emerged through a cumulation of factors. Four categories of factors were identified: (1) structural factors, including limited access to health care professionals and a lack of necessary information, (2) illness related factors such as sudden progression in the illness trajectory and symptoms, (3) the intensity of care involvement and (4) emotional and psychological burden of family caregivers. A diverse range of protective strategies were employed by family caregivers, encompassing the involvement of the social network, the pursuit of information and the identification of a sense of purpose. Conclusion: The findings of this study confirm the importance of providing continuous, competent, and empathetic care to both family caregivers and patients in palliative outpatient care. The study highlights the importance of expanding the palliative care infrastructure, as well as ensuring unrestricted access to palliative care professionals, developing tailored information tools for family caregivers, and reducing bureaucracy. Further studies are needed to identify additional influencing factors and evaluate effective measures. [ABSTRACT FROM AUTHOR]

Background: Kenya launched a Rabies Elimination Strategy in 2014, aiming to end human rabies deaths by 2030. In March 2022, Lamu County reported increased cases of human dog bites and suspected rabies deaths to the Ministry of Health (MoH). We aimed to establish the extent of the rabies outbreak in humans and animals and determine the challenges to achieving rabies elimination by 2030. Methods: We extracted dog bite reports from the Kenya Health Information System (KHIS), national surveillance database system, and reviewed medical records at health facilities in Lamu County for suspected human rabies deaths from 2020 to 2022. We obtained information about animal bites and illnesses in deceased persons, checked the availability of anti-rabies vaccines in health facilities, and administered rabies knowledge and practice questionnaires to health workers. For categorical data, frequencies and proportions were determined. Results: There were 787 dog bite cases and six human rabies cases. Only a third (2/6) of the rabies cases were uploaded to the KHIS. The county used targeted dog vaccination, and samples were not collected from the biting dogs. Regarding the availability of human rabies vaccines, half (8/16) of the facilities had the human rabies vaccine, and 19% (3/16) had both the human rabies vaccine and rabies immunoglobulin (RIG). Rabies vaccine stock-outs were common at 73% (11/16). Only 25% (18/73) of the health workers reported their first action would be to clean the bite wound with running water and soap for 15 min. Additionally, 86% (54/63) did not know the recommended human rabies vaccine and RIG dosage and schedule, while 25% (18/73) of healthcare workers were satisfied with the existing information-sharing mechanisms between veterinary and human health departments for rabies prevention and control. Conclusions: There was underreporting of rabies cases, a lack of awareness of bite wound management at health facilities, and persistent stockouts of human rabies vaccines. We suggest training healthcare workers on animal bite case management and improving One Health information exchange. Author Summary: Kenya launched a national rabies strategy plan in 2014 with the goal of eliminating dog-mediated rabies by 2030 through mass dog vaccinations, pre-exposure and post-exposure prophylaxis, and enhanced rabies surveillance. During a rabies outbreak investigation in Lamu, using a mixed methods investigation approach, we identified some challenges which include poor rabies surveillance, use of targeted dog vaccination, a lack of one-health collaboration, inadequate knowledge and practice of dog bite wound management by healthcare workers and the animal bite victims which contribute to Kenya's missing rabies elimination milestones despite the existence of the rabies elimination strategy. We recommend enhancing rabies surveillance, adopting one health approach, training healthcare workers on proper animal bite wound management, and upscaling from targeted to mass dog vaccination. [ABSTRACT FROM AUTHOR]

Malaria is a major public health concern and requires quality data management system for effective preventive measures. The District Health Management Information System (DHMIS II) has been used to routinely capture data at health facilities. However, little is known about the quality of routine malaria data captured on the DHIMS II database in Community-Based Health Planning and Service (CHPS) compounds. The study therefore determined the quality of routine malaria data captured on the DHIMS II database in CHPS compounds in the Hohoe Municipality, Ghana. A retrospective cross-sectional analysis of Out Patient Department (OPD) malaria indicators was conducted using data from January 2018 to December 2022 at CHPS compounds in the Hohoe Municipality. Data were collected from three sources: the DHIMS II, monthly morbidity report forms, and consulting room registers. The study assessed three (3) malaria indicators: suspected malaria cases, tested malaria cases, and confirmed OPD malaria cases. A data validation tool was developed to determine the quality of malaria indicators measuring availability, completeness (percentage of missing data), and accuracy. The data was analysed descriptively using Microsoft excel. Out of the four (4) health facilities, 50% (2/4) met the suggested target of (≥ 90%) in 2018 and 2020 whiles all the (4) facilities met the recommended target in 2021 and 2022 for the availability of monthly OPD morbidity reports. For the availability of monthly data returns on anti-malarial, none of the facilities met the recommended target from 2018 to 2022. All 4 facilities met the recommended target in 2021 and 2022. For completeness of source data, 25% of the facility had complete data that met the required target in specific years (2021–2022). For accuracy, 50% of the facilities showed accurate reporting with a Good (± 5%) accuracy level. The remaining 50% underreported data, resulting in a Poor (± 11–20%) accuracy level. The study finds that while half of the facilities had reliable and complete malaria data in their source registers, there are inconsistencies with the DHIMS II database regarding the standards of data quality. Most facilities faced significant issues like unavailability of data, uncompleted data and underreporting of data, making it not-advisable to rely on DHIMS II for critical health decisions. Although, half of the facilities showed evidence of good data quality, there is still a need for improvement in the capturing of routine malaria data. [ABSTRACT FROM AUTHOR]

Background: Despite the high demand for public services globally, ensuring the quality of services provided by public health facilities is challenging. Poor remuneration of public sector health care providers (HCPs) drives their migration to private health facilities. The Dual Clinical Practice (DCP) Policy in Rwanda represents a strategic initiative aimed at retaining healthcare professionals in public health facilities, allowing them to engage in private practice concurrently. This study assesses the implementation challenges and identifies opportunities for potential reformulation of DCP schemes. Methods: This study employed a mixed methods approach, incorporating both cross-sectional and retrospective designs across six Rwandan public hospitals. Quantitative and qualitative data were collected through key informant interviews (KIIs) and joint interviews (JIs), as well as through the analysis of health facility records obtained from the Health Management Information System (HMIS) and the Electronic Medical Record (EMR). Qualitative data were analyzed using Atlas.ti software, while quantitative data were analyzed using Microsoft Excel. Results: The study involved participants from six Rwandan hospitals, including 20 healthcare providers and 32 patients. Qualitative results revealed that a substantial majority of health care providers supported the DCP policy, with a high patient satisfaction rate of 81% regarding DCP services. However, challenges emerged, including limited awareness of the policy and difficulties in tracking DCP engagements. Quantitative data from the HMIS and EMR indicated an increase in patient enrollment across most facilities, with DCP outpatient visits accounting for a significant percentage of total visits in some hospitals. While the DCP contributed positively to hospital revenues, concerns about the sustainability of the scheme and the adequacy of health care remuneration were highlighted, calling for a review of DCP policy involving stakeholders beyond the Ministry of Health. Conclusion: This study found that the DCP policy in Rwanda positively impacted healthcare provider retention, patient satisfaction, and hospital revenues. Providers expressed strong support for the policy, and patient satisfaction was high, with 81% of patients reporting positive experiences with DCP services. The scheme contributed to increased patient enrollment and hospital revenue, particularly in urban facilities. However, challenges, such as limited awareness of the policy among healthcare providers and difficulties in tracking DCP engagements, were noted. Additionally, concerns about the sustainability of the DCP and the adequacy of healthcare remuneration highlighted the need for policy revisions. To address these challenges, a collaborative approach involving stakeholders such as tax authorities, hospital administrations, and health insurance companies is necessary. Additionally, our study highlights the critical role of investments in physical infrastructure to support the long-term success of DCP. Enhancing infrastructure would not only ensure better healthcare quality but also support the retention of providers in both urban and rural settings. [ABSTRACT FROM AUTHOR]

• Knowledge on the impact of long-term exposure to ambient air pollution on peripheral artery disease is limited • We investigated 14.629 incident cases from a population at risk of 1.719.475 in the frame of the Rome longitudinal study • PM 2.5 was positively associated with peripheral artery disease and associations were also obtained for nitric dioxide and black carbon. • Concentration-response curves for these air pollutants showed a risk increase already at low concentrations • These data show that the environment is a strong determinant of cardiovascular risk also for peripheral artery disease The association between air pollution and cardiovascular diseases is well established. However, fewer studies focused on the relationship between air pollution and peripheral artery disease (PAD), notwithstanding that not only it is a predictor of CVD mortality but also that incidence is globally rising, particularly in low-middle income countries. The aim of this study is to estimate the association between long-term exposure to air pollutants and the incidence of PAD in the Rome Longitudinal Study (RLS) during 2011–2019. Using the Health Information Systems, we identified the first episodes of hospitalizations with discharge diagnosis for PAD (ICD-9 codes: 440.20-24; 444.0; 444.21; 444.22; 444.81; 447.1), lower limb vascular surgery (ICD-9 codes: 38.18; 39.29; 39.50; 39.90; 84.11; 84.12; 84.15; 84.17) or drug prescription (ATC code: B01AC23) in the period 2011–2019. In order to focus on incidence, we excluded from the population at risk prevalent cases based on hospital discharges in the 10 years before enrolment (October 9th, 2011). We assigned to the participants one-year average exposure to PM 2.5 , NO 2 and black carbon (BC) from the ELAPSE Europe-wide hybrid land-use regression (LUR) models at 100 m2 spatial resolution on the basis of their baseline geocoded addresses. We also applied Cox regression models adjusted for individual and area-level covariates. The estimates were expressed as hazard ratios (HR) and 95 % confidence intervals (95 % CI) per pollutant-specific interquartile range (IQR) increase. We also analyzed any effect modification by socio-demographic and comorbidity variables and explored concentration-response curves using natural splines with 3 degrees of freedom. Starting from a population at risk of 1,719,475 subjects aged 30 years or above, a total of 14,629 incident cases were identified. An IQR (1.13 μg/ m 3) increase in PM 2.5 was positively associated with a HR of 1.011 (95 % CI: 0.988, 1.034). Positive associations were also obtained for NO 2 ([IQR 7.86 μg/ m 3 ] HR: 1.022 (95 % CI: 0.998, 1.048)) and black carbon ([IQR 0.39 x 10 − 5 /m] HR: 1.020 (95 % CI: 0.994, 1.047)). Effect modification analysis showed stronger associations when considering males and individuals in the 55–69 age class. Concentration-response curve for NO 2 showed a linear shape, with increases of risk already at low concentrations. Long-term exposure to PM 2.5 , NO 2 and BC is associated with an increased incidence of PAD, and male subjects and individuals aged between 55–69 years were at greater risk. [ABSTRACT FROM AUTHOR]

Background: Socio-economic inequalities significantly impact paediatric cancer survival. The review aims to elucidate the facilitators and barriers influencing the availability and accessibility of essential medicines for childhood cancer (EMCC) in low- and lower-middle-income countries (LLMICs). Methods: This systematic review was conducted adhering to the PRISMA guidelines. Peer- reviewed primary studies, national/regional reports, and policy documents published in the English language were included through a thorough literature search using three electronic databases: MEDLINE, EMBASE, and CINAHL. Review questions were framed according to the ECLIPS framework. Children under 19 years of age living in LLMICs diagnosed with any malignancy were the client group. The quality of the included studies was assessed using the mixed methods appraisal tool. Data is presented as a narrative synthesis. Enablers and barriers were discussed based on the World Health Organization (WHO) health system building blocks. Results: Out of the 29 articles retrieved for full-text screening, the final synthesis included nine articles. Six were based on quantitative, two on mixed-method research, and one was a review article. These studies represented 26 LLMICs from several continents (Africa, Asia, and America). The alignment of the National Essential Medicine Lists (NEMLs) with the World Health Organization Essential Medicine List for Children (WHO EMC) varied from 40%- 60%. Overall stock out rate ranged from 17 to 100%. Stock out rate was higher in the public sector than in the private sector. International partnerships, policy changes, and financing strategies are some of the key enablers identified. Barriers included inadequate global drug production, high drug costs, weak regulatory enforcement, poor supply chain management, and insufficient health information systems. Conclusion: The findings of our review revealed the failure of LLMICs to meet the WHO- recommended target of 80% availability for EMCCs. The availability and accessibility of EMCC in LLMICs are hindered by multiple systemic barriers despite several enabling strategies. Addressing these challenges requires coordinated global efforts and local initiatives to ensure equitable access to childhood cancer treatments in LLMICs. PROSPERO registration number: CRD42022334156. [ABSTRACT FROM AUTHOR]

Background: Nigeria's reproductive, maternal, newborn, child, and adolescent health indicators have remained unsatisfactory in the face of poor-quality healthcare services. Nigeria initiated the reproductive, maternal, newborn, child, and adolescent, elderly + nutrition (RMNCAEH+N) quality of care (QoC) agenda to address the challenge. The health management information system (HMIS) is integral to the agenda but there is sparse evidence on its performance so far. This study assessed the performance of routine HMIS for RMNCAEH+N QoC in Ondo and Ekiti States. Methods: This paper described the review of health facility records and health facility survey components of a multi-component study which employed a mixed-method research design. Using the routine health information system performance diagnostic tool, service data captured for over one year were critically reviewed in randomly selected sample of 169 public health facilities (Ondo:117; Ekiti:52) and information was obtained from facility heads or designates. Performance of routine HMIS for RMNCAEH+N QoC in terms of data collection, data quality, and data use were analysed using univariate and bivariate statistics. Results: Results show that 67.3% of health facilities in Ekiti and 88.9% of facilities in Ondo had all required HMIS tools for selected RMNCAEH+N services (p<0.001). Data accuracy was 70.1% for Ondo and 40.4% for Ekiti (p <0.001); 82.9% of facilities in Ondo and 44.2% in Ekiti had complete data (p <0.001); almost all facilities (Ondo: 99.1%; Ekiti: 96.2%, p = 0.224) demonstrated data consistency; and, 82.9% of facilities in Ondo and 94.2% of facilities in Ekiti demonstrated timeliness in data submission (p = 0.048). Also, 70.1% (Ondo) and 78% (Ekiti) of facilities had quality improvement (QI) teams (p = 0.338); 53.5% (Ondo) and 77.1% (Ekiti) of QI teams regularly extracted data, calculated, and visualised prioritized indicators (p = 0.007); while 72.1% (Ondo) and 79.2% (Ekiti) regularly reviewed data and used it to make QI decisions (p = 0.367). Conclusion: Routine RMNCAEH+N QoC data management system in Ondo and Ekiti States vary in terms of the status of reporting forms, data quality, and data use for decision-making, and there were specific performance gaps. The routine RMNCAEH+N QoC data management system in Ondo and Ekiti States needs improvement and findings from this study can serve as the basis for evidence-based advocacy for the required efforts and investment toward improved performance. [ABSTRACT FROM AUTHOR]

Background: Non-governmental organisations (NGOs) have the potential to make a significant contribution to improving health system goals through the provision of resources, health services and community participation. Therefore, this paper examines the role of NGOs in achieving health system goals, based on the six building blocks of a health system framework, and identifies strategies to enhance NGO involvement in achieving health system goals. Methods: A scoping systematic review methodology was used to map and synthesise the existing literature on the topic, following the latest JBI six-stage framework. Four databases and one search engine including PubMed, Web of Science (ISI), EMBASE, Scopus and Google Scholar were searched from January 2000 to January 2024. The results were synthesised using a directed content analysis approach, and the findings were categorised according to the dimensions of the six building blocks. Results: NGO involvement in health system goals can effectively address gaps in service delivery, strengthen the health workforce, improve health information systems, increase access to essential medicines, mobilise resources and promote good governance. In addition, six key strategies were identified, including joint planning, policy development, capacity building, resource allocation, developing collaboration, and improving the quality of health care, to enhance NGO participation in achieving health system goals. Conclusion: NGOs can play a critical role in achieving health system goals, alongside government and other key health stakeholders. Governments need to use evidence-based policies and interventions to support NGOs to realise their potential in achieving health system goals. [ABSTRACT FROM AUTHOR]

Background: HIV and HBV remain significant public health challenges characterized by high prevalence, morbidity, and mortality, especially among women of reproductive age in Uganda. Patients with HBV do not receive routine counselling and education, and there are limited resources for laboratory investigation coupled with a high loss to follow-up. This study set out to assess barriers and facilitators of integrated viral hepatitis B C and HIV care model to optimize screening uptake among mothers and newborns at health facilities in Koboko District, west Nile sub-region, Uganda. Methods: An exploratory qualitative descriptive study that used an inducted and deductive thematic analysis approach was used at Health Centre III (HC IIIs) level in an institutional setting. The study participants (Key Informants) were both clinical and administrative health workers involved in the delivery of Hepatitis B, C, and HIV services. Data was audio recorded using a recording device and then transcribed after all interviews were conducted. Data was then analyzed using thematic analysis. Results: The facilitators of integration were established to be; High burden of hepatitis B infection, team spirit by the health workers, reduced long waiting time, availability of medical products such as HBV and HCV test kits, integration of HBV and HIV into Health Management Information System (HMIS) 2 data collection tools and availability of support from implementing partners such as Infectious Disease Institute which offered mentorship and training on integration and support supervision. While the barriers included; Knowledge gaps among healthcare workers, limited Health education, Language barriers that made communication between health workers and mothers difficult, constant stock out of test HBV kits, no supplies for HCV kits, and inadequate staffing. Conclusion: The need to reduce 'lost opportunity' by pregnant mothers in accessing HBV, HVC, and HIV at one point of care underscores the necessity of integrated care. Strong team spirit, reducing patient waiting times, and enhancing the incorporation of HBV and HIV into the HMIS2 form are essential steps. Additionally, support from implementing partners like IDI, is pivotal. Several barriers impede effective integration. Addressing knowledge gaps among healthcare workers, providing transportation, minimizing language barriers during health education, addressing insufficient human resources, and preventing frequent stock-outs of test kits for HBV and HCV are crucial to enhancing the effectiveness and efficiency of integration. [ABSTRACT FROM AUTHOR]

Introduction: The financial stability of hospitals directly impacts their ability to fulfill their primary mission of enhancing healthcare. This study identifies and prioritizes cost reduction and revenue enhancement strategies for Iranian hospitals. Method: This investigation employed a mixed-methods design, incorporating both qualitative and quantitative approaches. A systematic review of scholarly articles was initially conducted to identify key strategies for cost reduction and revenue enhancement in hospitals. Insights from hospital administrators regarding successful practices and recommended financial improvement measures were subsequently collected through surveys. The combined strategies from these phases were then assessed and ranked using the TOPSIS technique. Findings: This study identified 12 primary strategies and 71 sub-strategies across four dimensions. Notably, strategies aimed at enhancing the quality of care (0.9030), refining process quality (0.7926), and bolstering care provision infrastructure (0.7910) were deemed the most critical. Among the sub-strategies, priority was given to implementing a comprehensive health information system (HIS) (0.7926), identifying and reducing the causes of cancelled surgeries and visit appointments (0.7919), and developing strategies to decrease hospital infection rates (0.7854). Conclusion: Enhancing the quality of care and upgrading service delivery processes are crucial for improving hospitals' economic performance. Elevating service quality not only improves the economic performance of hospitals but also enhances their financial metrics. [ABSTRACT FROM AUTHOR]

Background: The Every Newborn Action Plan (ENAP) indicators are essential in monitoring neonatal healthcare coverage and quality. The District Health Information System (DHIS2), an open-source platform in over 80 countries, supports health data collection and analysis, enabling progress tracking at national and subnational levels. This study evaluates the availability and quality of maternal and newborn health indicators, explicitly focusing on ENAP indicators within Tanzania's DHIS2. Methods: Using the EN-MINI tool, we assessed data availability for 20 ENAP indicators by analysing their numerators and denominators in Tanzania's DHIS2 (2015–2022) across all healthcare levels. World Health Organization's (WHO) data quality framework was adapted to examine four dimensions: (a) availability of indicators, (b) completeness of indicator reporting, (c) internal consistency of related indicators, and (d) indicator plausibility by comparing DHIS2 data with population-based Demographic and Health Survey (DHS) data. Results: Of the 20 ENAP indicators, 14 were available in Tanzania's DHIS2, with definitions, numerators and denominators aligned with WHO standards. Between 2015 and 2022, the number of facilities reporting at least one delivery annually increased by 19% from 5,898 to 7,016. During this period, 75% to 97% of facilities consistently reported data on skilled attendance at birth and early breastfeeding initiation. In contrast, 4% to 54% of facilities reported on maternal and newborn outcomes, including complications such as stillbirths and maternal mortality. Internal consistency was high (> 94%). However, neonatal mortality rates reported in DHIS2 were lower than those reported in Tanzania DHS for similar periods, even after a 20% adjustment to account for home births. Conclusion: Tanzania's DHIS2 captures many ENAP indicators; however, notable variability in data quality persists, with substantial data gaps related to maternal and newborn outcomes and complications. To address these challenges, it is crucial to strengthen routine data review, implement robust quality checks, enhance validation processes, provide targeted training, deliver constructive feedback, and conduct supportive supervision. Placing greater emphasis on using DHIS2 data to monitor progress will help identify gaps and drive improvements in data quality, ultimately supporting better maternal and newborn health outcomes. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs. [ABSTRACT FROM AUTHOR]

Background: Kazakhstan inherited the Semashko health system model, known for the centralized adoption of rules at the Ministry of Health (MoH) level that regulate the healthcare system. In 2019 MoH established a national framework with indicators aimed at collecting qualitative and quantitative data from healthcare organizations as part of their annual self-evaluation, and biannual external evaluation by the National Research Center for Health Development (NRCHD). The purpose of this study was to pilot the MoH framework on rational use of medicines and evaluate its effects on medicine use practices in health care organizations and at the national level. Materials and methods: This cross-sectional study was conducted from October to December 2019 at 22 state-owned primary health care organizations (polyclinics) serving adults and children in Astana, Kazakhstan. Data were collected by trained surveyors visiting each organization. Data were converted to numeric values to arrive at compliance scores for each organization and analyzed to assess each organization's compliance with set indicators. Results: The evaluation showed the rational use of medicines was assessed as "excellent" (90% < compliant) in 2 organizations (9% of the sample), "good" (75–89% compliant) in 7 organizations (32%), and "satisfactory" (50–74% compliant) in 13 organizations (59%), with an average compliance rate of 71% across the sample. 22 organization-specific evaluation reports were developed by the evaluator (NRCHD) and sent to health care organizations for corrective actions. Evaluation data triggered two improvements at the national level: correction of the default setting for trade names to international nonproprietary names within the physician ordering feature of the national health information system for medicines, and adoption of a national policy that allowed the exchange of unused stocks of medicines between polyclinics. Conclusions: Using the national framework allowed the evaluator agency and healthcare organizations to identify organization-specific gaps and triggered improvements in the use of medicines. [ABSTRACT FROM AUTHOR]

Background: Quantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China. Methods: The EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021. Results: This study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017–2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period. Conclusions: The EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning. [ABSTRACT FROM AUTHOR]

All healthcare therapies are grouped into mainstream (allopathy) and complementary and alternative therapies (CAT). Yoga is a popular therapy that falls under CAT. People practice yoga to maintain and improve their health. Yoga consists of hundreds of postures, each with its own benefits and contraindications. Practicing Yoga requires a careful selection of appropriate asanas (that loosely translates to postures) at an individual level. We investigated the top 100 websites provided by Google when we searched for yoga asanas keywords. We discovered that all these websites provide generic recommendations to the users. Such recommendations could harm rather than help a user. In this work, we propose a personalized Yoga Assistant (YA) that consists of a data collection and preprocessing module and an Asanas Recommendation Engine (ARE). We have implemented ARE using state-of-the-art natural language processing (NLP) techniques, including BERT (Bidirectional Encoder Representations from Transformers), for data encoding. Ours is a multi-label learning model that uses the cosine similarity function to rank classes. We curated and developed a multi-label dataset consisting of 140 asanas that are easy (for beginners) or of intermediate difficulty level, enabling us to conduct thorough investigations into yoga asanas recommendations. The system suggests up to 15 asanas to a user based on her health conditions that she can safely practice. [ABSTRACT FROM AUTHOR]

The deployment of Health Information Systems (HIS) in Sri Lanka has been low in adoption compared to developed countries. There has been a dearth of studies to identify the factors that improve the adoption of HIS in developing countries. Thus, this study investigates the factors influencing the acceptance of HIS among public healthcare staff. A survey was administered among 170 medical professionals, including nurses and doctors. Partial Least Squares Structural Equation Modelling (PLS-SEM) was applied to the dataset with 5000 bootstrap subsamples. The research model was developed based on the prior literature and by extending the Technology Acceptance Model (TAM) to the context of public healthcare. A positive relationship was observed between the actual use of HIS and constructs such as perceived usefulness, perceived ease of use, attitude, behavioural intention, prior use of HIS by supervisors, computer anxiety and facilitating conditions. These findings confirm the applicability of the proposed extended TAM in the public healthcare system of a developing country. Furthermore, HIS practitioners and policymakers in the healthcare sector would find these results valuable. [ABSTRACT FROM AUTHOR]

Dengue remains a significant public health concern in Brazil, with all federative units registering occurrences of the disease within their territories despite constant measures to control the Aedes aegypti vector. This study aimed to evaluate the profile of notified dengue cases in the Brazilian Legal Amazon from 2001 to 2021, analyzing National System of Notifiable Diseases (SINAN) data on the disease to assess the risks for its occurrence. Subsequently, statistical analyses were conducted to identify incidence and lethality rates. Over the study period, approximately 1,344,950 cases of the disease were reported, resulting in 863 deaths. The transmission of cases in the Amazonian states was not homogeneous, demonstrating variations and clusters over the years of extreme value for health authorities. Identifying and understanding the spatiotemporal patterns for the disease in the region helps assess the behavior of infections in areas with high susceptibility, promoting targeted interventions and resource allocation for dengue control programs. It is important to encourage future studies that evaluate the disease's risk based on quantitative variables. Such studies contribute to the formulation of health policies aimed at controlling and preventing dengue, improving public health outcomes. [ABSTRACT FROM AUTHOR]

Background: Inequities in health care access lead to inequities in outcome. In recent years, health outcome disparities have been documented in children with acute appendicitis and sociodemographic predictors of imaging utilization have not been adequately assessed. Objective: The purpose of our study is to assess sociodemographic predictors for the diagnostic imaging of children with right lower quadrant (RLQ) pain. Our hypothesis is that disparities exist in imaging utilization. Materials and methods: Our nationwide retrospective cohort study of the Pediatric Health Information System (PHIS) database queried emergency department encounters for children aged 0–18 years presenting with RLQ pain (ICD code CM R10.31) between January 2018 and September 2023. Primary exposures included neighborhood-level sociodemographic metrics as measured by Child Opportunity Index, race/ethnicity, and insurance status. Outcomes included no diagnostic imaging, diagnostic imaging with radiography alone, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Multivariable logistic regression analyses assessed modality usage with respect to the primary exposures after controlling for demographic (age, gender) and additional (hospital geographic region, time of imaging) covariates. To avoid the perpetuation of bias, reference categories were determined by the lowest numerical value for each covariate. Results: In total, 100,161 patient encounters met inclusion criteria (mean patient age 11.2 years ± 3.9; 59.3%, n = 59,416 females). Imaging utilized was US (78.0%; n = 78,115), CT (16.4%, n = 16,405), no imaging (13.9%, n = 13,894), radiography alone (4.4%, n = 4,429), and MRI (3.1%, n = 3,148). The most predictive factors for no imaging were moderate, low, and very low Child Opportunity Index (aOR 1.25, 1.17, and 1.18 [95% CI 1.10–1.33] compared to very high Child Opportunity Index); Black race/ethnicity (aOR 1.26 [95% CI 1.11–1.44] compared to White or Asian race/ethnicity); and public or other insurance (aOR 1.23 and 1.32 [95% CI 1.18–1.41] compared to commercial insurance). The most predictive factors for radiography alone were Black race/ethnicity (aOR 1.30 [95% CI 1.17–1.45] compared to Hispanic race/ethnicity) and public or other insurance (aOR 1.26 [95% CI 1.11–1.44] compared to commercial). The most predictive factors for US were very-high Child Opportunity Index (aOR 1.16 [95% CI 1.09–1.22] compared to very low Child Opportunity Index); Asian, NH-White, or Hispanic race/ethnicity (aOR 1.33, 1.31, 1.30 [95% CI 1.18–1.40] compared to Black race/ethnicity); and commercial insurance (aOR 1.20 [95% CI 1.16–1.25] compared to public insurance). The most predictive factor for CT was White race/ethnicity (aOR 1.26 [95% CI 1.11–1.43] compared with Asian race/ethnicity) and the most predictive factor for MRI was Hispanic race/ethnicity (aOR 1.49 [95% CI 1.17–1.61] compared with Black race/ethnicity). The greatest predictor of cross-sectional imaging was a hospital's region, with CT most likely in southern hospitals (aOR 4.09 [95% CI 2.17–7.70] compared with northeast hospitals). Patient Child Opportunity Index did not predict the likelihood of cross-sectional imaging with CT or MRI in tertiary pediatric centers. Conclusion: Sociodemographic disparities exist in the imaging of children presenting to tertiary pediatric hospitals with RLQ pain. Future studies are needed to analyze the causes of such disparities both on hospital and departmental levels. [ABSTRACT FROM AUTHOR]

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its global spread have left an indelible mark, disrupting multiple aspects of human life. It is therefore crucial to retrospectively analyze the factors that have contributed more to the initial inefficiency of the global response, thus enhancing preparedness and proactively addressing the risk of similar events occurring in the future. Critical areas were identified based on our expertise. Relevant bibliographic references were subsequently gathered through an open search of scientific databases to substantiate the concepts discussed in this article. The key issues that hindered an effective response to coronavirus disease 2019 (COVID-19) are numerous and multifaceted, and some of these will be critically examined in this article, including delayed identification of the pathogen, inadequate public health preparedness, inadequate therapeutic management, and deficiencies in laboratory diagnostics. From this analysis, key areas for improvement emerge to ensure more efficient responses to future health crises, including (i) enhancing and strengthening health information systems, (ii) improving pandemic preparedness and response planning, (iii) developing a resilient healthcare workforce, (iv) increasing investment in research and development, (v) expanding the use of telemedicine and digital health, (vi) ensuring universal access to healthcare, and (vii) improving public health communication and trust. [ABSTRACT FROM AUTHOR]

Purpose: Online medical repositories provide a platform for users to share information and dynamically access abundant electronic health data. It is important to determine whether case report information can assist the general public in appropriately managing their diseases. Therefore, this paper aims to introduce a novel deep learning-based method that allows non-professionals to make inquiries using ordinary vocabulary, retrieving the most relevant case reports for accurate and effective health information. Design/methodology/approach: The dataset of case reports was collected from both the patient-generated research network and the digital medical journal repository. To enhance the accuracy of obtaining relevant case reports, the authors propose a retrieval approach that combines BERT and BiLSTM methods. The authors identified representative health-related case reports and analyzed the retrieval performance, as well as user judgments. Findings: This study aims to provide the necessary functionalities to deliver relevant health case reports based on input from ordinary terms. The proposed framework includes features for health management, user feedback acquisition and ranking by weights to obtain the most pertinent case reports. Originality/value: This study contributes to health information systems by analyzing patients' experiences and treatments with the case report retrieval model. The results of this study can provide immense benefit to the general public who intend to find treatment decisions and experiences from relevant case reports. [ABSTRACT FROM AUTHOR]

Background: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse. Objectives: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data. Method: Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used. Results: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001). Conclusion: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs. [ABSTRACT FROM AUTHOR]

Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema. [ABSTRACT FROM AUTHOR]

Background: Detailed information on the efficiency of health services targeting opioid use disorder (OUD) and treatment with opioid agonist treatment (OAT) is sparse. Many countries, including Norway, are still falling short of universal health coverage (UHC) of OAT. This study aims to evaluate the incremental lifetime costs and effects of treating OUD with OAT as compared to no OAT in Norway and scaling up the treatment to a universal coverage level using equity-adjusted health economic evaluations. Methods: We conducted cost-utility and budget impact analyses and constructed a two-state Markov model to compare the lifetime costs and outcomes among patients with OUD with and without OAT. Model inputs were derived from routine health information systems and the literature, with costs reported in 2023 Norwegian Kroner (NOK). The analyses were conducted from a Norwegian extended health-service and societal perspectives, with a lifetime time horizon. Quality-adjusted life years (QALYs) was the metric of health benefits. Outcomes were reported as incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was equity-adjusted according to the future prognostic healthy life year loss method in Norway (severity of disease criterion), which is sensitive to the size of future undiscounted healthy life year loss due to the affected conditions. The WTP threshold is NOK 825,000 per QALY gained in Norwegian policy for conditions with undiscounted future QALY loss > 20. Uncertainty in the parameters and robustness of the results were assessed with one-way and probabilistic sensitivity analyses and scenario analyses. Findings: The mean results from probabilistic sensitivity analysis estimated that OAT was associated with 3.03 additional discounted QALYs gain and incremental lifetime discounted cost of NOK 1.45 million, leading to an ICER of NOK 479,099 per QALY gained when compared with not providing OAT, with the extended health-service perspective. From a societal perspective, OAT was cost-saving, i.e. OAT produced greater health benefits while resulting in lower overall societal costs compared to no OAT. The mean undiscounted future health loss was estimated to be 21.34 QALYs for the Norwegian patient group with OUD. A total 5-year budget increase of NOK 1.208 billion was estimated if OAT was going to be scaled up from the current coverage level of 70% to UHC. Compared with the current coverage, 100% coverage of OAT was associated with an additional lifetime cost of NOK 4.332 billion but also an additional 6760 QALYs gained. Conclusion: Our analysis suggests that OAT is cost-effective in Norway and has the potential to be cost-saving from a societal perspective. Therefore, Norwegian policy should consider scaling up treatment to extend the coverage of OAT. [ABSTRACT FROM AUTHOR]

To develop a customized individual-based electronic immunization registry using the DHIS-2 platform and investigate its effectiveness combined with short message service reminders to decrease the child immunization dropout rate and improve vaccination timeliness in the Duhok Governorate. This was a quasi-experimental study. The study included a preliminary pilot assessment examining deficiencies and requirements of the current paper-based immunization system, which informed the development of a tailored electronic immunization registry. This registry was implemented in a quasi-experimental study at four randomly selected vaccination units at primary healthcare centers with high dropout rates in Duhok Governorate, targeting 390 children under one year who were vaccinated or eligible to be vaccinated with the PENTA-1 vaccine and followed up for five months to receive successive doses of the PENTA-2 and PENTA-3 vaccines. The children were distributed into two groups: 195 children in the intervention group, whose children's information was entered into the electronic immunization registry and whose parents received vaccination appointment reminders, and 195 children in the control group, whose children received the regular vaccination service, information entered into the paper-based immunization registry, and did not receive vaccination appointment reminders. The results showed a statistically significant decrease in the PENTA-1 to PENTA-3 dropout rate among children enrolled in the intervention group (5.7 % compared to 29.7 % in the control group, p-value< 0.001). This study offers compelling evidence that implementing the DHIS-2 platform tracker EIR with SMS reminders is an effective tool for significantly enhancing the child immunization program's outcomes. It also guides the implementation of an individual-based electronic immunization registry using the DHIS-2 tracker module by the national health team. Therefore, we recommend adopting its application to encompass a broader spectrum of vaccines and health facilities nationwide. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patient satisfaction is a paramount measure of the quality of healthcare system, particularly in the practice of family medicine. The study aimed to assess patients' satisfaction with services provided by family physicians (FPs) at Comprehensive Healthcare Centers (CHCCs) in Northern Jordan. MATERIALS AND METHODS: A cross-sectional study was conducted at 11 CHCCs in Northern Jordan between July and October 2023. A convenient sample of 367 patients, both males and females over the age of 18 years, was selected. Participants were requested to complete the Arabic version of the Consultation Satisfaction Questionnaire (CSQ). Mean and standard deviation calculated for continuous variables, and frequencies and percentages for categorical variables. Multivariable logistic regression analysis yielded factors related to patients' satisfaction with family physician. RESULTS: The mean score of patients' satisfaction was 55.63 ± 12.15. The highest mean satisfaction scores were reported for the "professional care" provided by the FP (72.41 ± 15.9), followed by the "depth of relationship and the length of consultation" with the FP, respectively. Patients who had a reference health center if needed (P < 0.002), had health insurance (P < 0.05), patient's privacy (P < 0.027), and waiting time < 20 min to see the FP (P < 0.001) were all positively associated with the status of patients' satisfaction. Logistic regression final model included only two factors, waiting time < 20 minutes and having a reference health center. CONCLUSION: The study reveals moderate patient satisfaction with care provided by FP. The moderate satisfaction is attributed to good care provided by FP and the least to the length of consultation. The predictors of satisfaction are the waiting time to see FP and the availability of a reference health center. Study has implications for the health care system in Jordan, as regards the strengthening of the health information system to incorporate policies on appointments, quality of consultation times, and waiting times. [ABSTRACT FROM AUTHOR]

ABSTRACT Public health nurses (PHNs) and school nurses are integral in addressing health disparities, managing chronic illnesses, preventing and controlling communicable diseases, and promoting wellness within communities. Schools serve as pivotal platforms for implementing health initiatives and providing opportunities for disease prevention and health promotion. School nurses identify and address health risks, including chronic conditions, communicable diseases, substance abuse, and mental health concerns, and often act as knowledgeable authorities to access community resources. PHNs perform a vital role in communicating the health experiences of diverse and sometimes vulnerable individuals and families to health planners and policymakers. They also empower community members to articulate concerns and goals, promoting a collaborative approach to public health development. Collaboration between PHNs and school nurses enhances community health through joint efforts in screenings, health education, and community‐wide interventions. However, barriers, such as isolated strategic planning, siloed funding, and inadequate information systems, hinder effective collaboration. The authors advocate for joint strategic planning, integrated funding, and interoperable health information systems that may now be fragmented to strengthen these partnerships in order to improve population health. Enhancing these collaborations is vital for creating supportive environments where students can thrive academically and health‐wise, ensuring a sustainable impact on community health. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the association of parenteral epinephrine and terbutaline use on ventilatory support in children admitted to the intensive care unit (ICU) with critical asthma in the United States. Methods: Data were obtained from the Pediatric Health Information System data base for children ages 2 to 18 years admitted to the ICU with a diagnosis of asthma exacerbation from January 1, 2016, to December 31, 2023. The primary outcomes included noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV) use after receipt of terbutaline and/or epinephrine. Secondary outcomes included serious adverse events from parenteral bronchodilators, including arrhythmias and elevated troponins. Results: Our study population included 53,328 patient encounters. Terbutaline and epinephrine were associated with decreased odds of subsequent NIV (terbutaline: odds ratio [OR] 0.52 [95% confidence interval {CI}, 0.44-0.63], p < 0.001; and epinephrine: OR 0.49 [95% CI, 0.43-0.55], p < 0.001) and subsequent IMV (terbutaline: OR 0.51 [95% CI, 0.42-0.61], p< 0.001; and epinephrine: OR 0.34 [95% CI, 0.29-0.41], p< 0.001). There were no differences in adverse events in the terbutaline group when compared with the epinephrine group for both arrhythmia and elevated troponins (arrhythmia: terbutaline = 1.9%, epinephrine = 1.7%; p = 0.6; and elevated troponins: terbutaline = 0.1%, epinephrine = 0.1%, p > 0.9). Conclusion: Parenteral bronchodilator use was associated with decreased odds of receiving subsequent ventilatory support in critical asthma. There were low rates of arrhythmia and elevated troponin overall. Our findings should inform future clinical trials to evaluate the use of parenteral bronchodilators in critical asthma in the United States. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the readability of Turkish-language texts that provide information about the relationship between gingival diseases and heart health on the internet. Material and Method: The keywords "gingival diseases and heart health relationship" were entered into the Google search engine. As a result of the search, the first 60 pages with Turkish content that provided patient information on the subject and could be accessed directly without any membership requirement were included in the study. Repeated web pages, academic publications, images, video content, and sites for advertising commercial products were not included in the study. The texts obtained were evaluated according to the Ateşman Readability Index. Results: Forty-six of the first 60 sites found in the search met the inclusion criteria. When the texts included in the study were examined according to their sources, it was found that 43.5% were pages of dental clinics, 26.1% of private hospitals, 10.9% of university hospitals, 10.9% of media news pages, 4.3% of professional organizations, 2.2% of cardiology clinics and 2.2% of state hospitals. It was determined that 60.87% of the texts on the pages were at "medium" and 39.13% were at "difficult" readability level. Conclusion: According to the results of the study, it was determined that the informative texts about "The relationship between gingival disease and heart health" published on Turkish websites have medium and difficult readability levels. In order to make such informative texts easier and comprehensible to read, it would be useful to adjust the language level of the text by using readability tools by the author before publication. [ABSTRACT FROM AUTHOR]

Namibia is characterized by a fragmented health-care system that has led to data inconsistencies and duplication of efforts. It has also become costly to health-care institutions to maintain these fragmented, standalone systems. This study examined how enterprise architecture (EA) can be applied to guide the integration of health information systems (HISs) in the Namibian health-care context. A qualitative approach was applied to collect data from two cases using semi structured interviews and an interpretive approach in the analysis. From the analysis, the constructs of requirements clarity, information systems and technology (IS/T) project management, systems documentation, and communication were discovered to influence the development and integration of HISs. Applying these constructs, the study developed an EA guide for the development and integration of HISs. The study recommends that future studies consider developing similar architecture using a quantitative approach and possibly validating the developed guide using a quantitative approach. [ABSTRACT FROM AUTHOR]

Namibia is characterized by a fragmented health-care system that has led to data inconsistencies and duplication of efforts. It has also become costly to health-care institutions to maintain these fragmented, standalone systems. This study examined how enterprise architecture (EA) can be applied to guide the integration of health information systems (HISs) in the Namibian health-care context. A qualitative approach was applied to collect data from two cases using semi structured interviews and an interpretive approach in the analysis. From the analysis, the constructs of requirements clarity, information systems and technology (IS/T) project management, systems documentation, and communication were discovered to influence the development and integration of HISs. Applying these constructs, the study developed an EA guide for the development and integration of HISs. The study recommends that future studies consider developing similar architecture using a quantitative approach and possibly validating the developed guide using a quantitative approach. [ABSTRACT FROM AUTHOR]

Simple Summary: A new animal mortality monitoring platform, named DATASIMA, was utilized to track and record cases of animal euthanasia in the municipality of João Pessoa, Brazil. This system was designed to help understand why animals, such as dogs and cats, die or are euthanized, providing accurate data on their causes of death. From April to September 2022, 403 animals were euthanized at a Zoonoses Control Center in the city, with the most common reasons being infections like sporotrichosis in cats and leishmaniasis in dogs. Other causes included diseases such as canine distemper and injuries from vehicle accidents, which affect both species. DATASIMA also helped map areas where these health issues were most prevalent, offering valuable information for local health authorities to develop targeted health strategies and better address zoonotic disease outbreaks in the community. The literature regarding causes of animal mortality varies greatly in how it evaluates and describes reasons for euthanasia, showing a clear need for tools to identify, standardize, and map diseases. This study describes the application of the Animal Mortality Information System Database (DATASIMA) to monitoring and georeferencing animal mortality. An observational study was conducted on the dogs and cats euthanized at the Municipal Center for Environmental and Zoonotic Surveillance in João Pessoa, Paraíba. The deaths were reported through DATASIMA, an online platform created and developed in Brazil, which is aimed at observing animal mortality through the Animal Death Declaration between April and September 2022. A total of 403 euthanized animals were recorded, including 204 dogs and 199 cats. The most common diseases leading to euthanasia were as follows: (i) Sporotrichosis (171 cats); (ii) Leishmaniasis (75 dogs); (iii) Distemper (35 dogs); (iv) Trauma from vehicle collisions (ten dogs and nine cats). The DATASIMA platform proved to be an effective system for keeping records and reporting causes of animal mortality. Through georeferencing, it was possible to map areas with higher frequencies of zoonotic outbreaks in the municipality studied, thus providing useful data to implement health promotion strategies. [ABSTRACT FROM AUTHOR]

Introduction: Ecosystem-centered healthcare innovations, such as digital health platforms, patient-centric records, and mobile health applications, depend on the semantic interoperability of health data. This ensures efficient, patient-focused healthcare delivery in a mobile world where citizens frequently travel for work and leisure. Beyond healthcare delivery, semantic interoperability is crucial for secondary health data use. This paper introduces a tool and techniques for achieving health data semantic interoperability, using reusable visual transformation components to create and validate transformation rules and maps, making them usable for domain experts with minimal technical skills. Methods: The tool and techniques for health data semantic interoperability have been developed and validated using Design Science, a common methodology for developing software artifacts, including tools and techniques. Results: Our tool and techniques are designed to facilitate the interoperability of Electronic Health Records (EHRs) by enabling the seamless unification of various health data formats in real time, without the need for extensive physical data migrations. These tools simplify complex health data transformations, allowing domain experts to specify and validate intricate data transformation rules and maps. The need for such a solution arises from the ongoing transition of the Estonian National Health Information System (ENHIS) from Clinical Document Architecture (CDA) to Fast Healthcare Interoperability Resources (FHIR), but it is general enough to be used for other data transformation needs, including the European Health Data Space (EHDS) ecosystem. Conclusion: The proposed tool and techniques simplify health data transformation by allowing domain experts to specify and validate the necessary data transformation rules and maps. Evaluation by ENHIS domain experts demonstrated the usability, effectiveness, and business value of the tool and techniques. [ABSTRACT FROM AUTHOR]

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aims to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data were collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy and DHIS2 documentation. Content and thematic data analyses were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In the early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform are analysed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio and Anthrax have been tracked in real-time through the eCBDS. [ABSTRACT FROM AUTHOR]

Background: WHO and its partners have adopted alternative control interventions since the failure to eradicate malaria worldwide in the 1960s and 1970s. The aim of these interventions has been to redesign the control interventions to make them more effective and more efficient. The purpose of this study is to assess the population impact of control interventions implemented at the community health area level. Methods: The analysis used data from the health information system on malaria cases and interventions (distribution of long-lasting insecticide-treated nets (LLINs), seasonal malaria chemoprevention (SMC), access to rapid diagnostic tests (RDT), intermittent preventive treatment for pregnant women (IPTp)) collected in the Kati health district from 2017 to 2020. And the contextual parameters (temperature, normal difference vegetation index (NDVI) and rainfall) were obtained by remote sensing. A generalized additive model was used to assess the impact of malaria control interventions on malaria cases as a function of meteorological factors. Results: The incidence of malaria varies from year to year and from health area to health area, as do meteorological factors in the study area. The distribution of long-lasting insecticide-treated nets, chemoprevention of seasonal malaria in children and access to rapid diagnostic tests for malaria were found to have a significant impact on the incidence of malaria in the population. Seasonal malaria chemoprevention was effective in reducing the incidence of malaria, while distribution of long-lasting insecticide-treated nets and access to rapid diagnostic tests increased with the number of malaria cases, reflecting efforts to distribute and use bed nets and to diagnose malaria cases among the population in the study area. Conclusion: The study showed the impact of SMC on reducing malaria cases in the population and the significant efforts in LLIN distribution and malaria case diagnosis. To further reduce the burden of malaria, sustained efforts and new interventions are needed, including improving access to rapid diagnosis and treatment in communities by developing community health workers and locally tailored mass drug administration. [ABSTRACT FROM AUTHOR]

The article discusses the importance of focusing on the health needs of migrant children and adolescents in Europe, highlighting the significant impact of migration on their well-being. It emphasizes the need for a systemic approach to migrant health, especially in the field of paediatric migrant health, recognizing the unique challenges and vulnerabilities faced by minors. The article calls for collaborative efforts and participatory research to address the structural health inequalities affecting migrant populations and enhance public health in Europe. [Extracted from the article]

Background: Non-communicable diseases contribute to a significant global burden of disease and are associated with modifiable risk factors such as physical inactivity, unhealthy diet, tobacco use and excessive alcohol consumption. These risk factors are closely related with lifestyles and eating patterns which are often culturally embedded and managed differently in various health care settings. Aim of the study: To assesses the applicability and feasibility of the KAPS (Knowledge, attitude, and practice) survey in generating data about knowledge, attitudes, and practices about healthy lifestyles within eastern Mediterranean settings and providing foundations for testing other models or development of a newer model in this area which captures and influence behavior changes towards healthy lifestyles. Methods: The KAP survey was tailored to capture the construct of healthy lifestyles (within the context of Qatar primary care settings) by reviewing existing surveys, adaptation to local context, expert consultation and feedback, pilot testing, feedback analysis, cognitive interviews and translation and validation. Results: The study reports that most participants found the content comprehensive, relevant, easy to understand but considered it lengthy. Analysis of grading of the 73 questionnaire items (complete questionnaire included as supplementary document) included by the panel of experts (n = 13) demonstrated that more than half of questions (52.1%) have a CVR value of 1. Thematic analysis of overall perceptions of the service users (n = 11) pertaining to the feasibility of the KAP survey identified three important themes which included i) clarity & readability of the questions ii) relevance of the instrument and iii) factors influencing service users' participation in survey. Conclusion: A culturally sensitive and region specific KAP tool specifically designed for healthy lifestyles can aid in health advocacy, monitoring modifiable risk factors, capturing rich epidemiological data to design preventive interventions, surveillance of high risks patients and strengthening the existing health information systems. Further research is needed to explore evidence-based methodologies to formulate an age-specific and shorter version of KAPs survey without compromising the validity of the tool within specific regional primary healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Multidrug resistant tuberculosis (MDR-TB) is a global public health threat. In 2021, an incidence of 3.6% was reported among new TB patients, and 18% was reported among previously treated patients. The emergence of the COVID-19 pandemic impacted the health sector, although little is known about the effect of restrictive COVID-19 measures on MDR-TB case notifications and treatment outcomes in Uganda. This study aimed to assess the effect of COVID-19 restriction measures on MDR-TB case notifications and treatment outcomes at treatment centres in Uganda. Methods: This was a retrospective cohort study in which a total of 483 participants were enrolled—238 before (March 2018-February 2020) and 245 during (March 2020-February 2022) COVID-19 restrictions. The data were extracted from the Drug-Resistant Tuberculosis (DR-TB) Health Management Information System (HMIS), and patient charts, and census sampling was employed. Interrupted time series (ITSA) was used to compare MDR-TB case notifications and treatment outcomes. Results: Before the COVID-19 restrictions, the majority 58.0% were aged less than or equal to 38 years whereas during the restrictions, the majority 51.8% were aged greater than 38 years. A total of 238 cases of MDRTB were reported before, and 245 cases were reported during the restrictions. There was no immediate (β2; 0.134) or sustained (β3; 0.494) impact of COVID-19 restriction measures on monthly MDR-TB case notifications. The mean number of monthly MDR-TB notifications was similar for the 3-month period before (11.0 cases per month) and during (10.0 cases per month) the COVID-19 restrictions (p-value 0.661). The proportions of patients who achieved successful MDR-TB treatment before (81.5%) and during (81.7%) COVID-19 restriction was not significantly different (p- value < 0.001). During the COVID-19 restrictions, not being married (aPR 0.85, 95% CI: 0.74—0.97) and treatment delay greater than 7 days (aPR 0.87, 95% CI 0.78—0.96) were negatively associated with successful treatment outcomes. Conclusion: Restrictive COVID-19 measures did not affect MDR-TB case notifications or treatment outcomes. Not being married and having a treatment delay greater than 7 days reduced the chances of a successful treatment outcome during COVID-19. The WHO and MoH should continue strengthening active case finding, contact screening and community engagement to consolidate MDR-TB control and management in preparation for similar future pandemics. [ABSTRACT FROM AUTHOR]

Background: HIV remains a significant public health problem, particularly in Africa, where two-thirds of global cases occur. Nigeria is among the three countries with the highest burden. Despite free access to pre- and post-exposure prophylaxis (PrEP and PEP) in Nigerian hospitals, stigma, distance, and restrictive clinic hours hinder uptake, especially among vulnerable populations. Building on the successful pilot implementation of pharmacy-based PrEP delivery in Kenya, we engaged Nigerian stakeholders in adapting the model, addressing user and provider concerns to ensure effective implementation in Nigeria. Methods: The stakeholder meeting took place in Abuja, Nigeria, which is selected for its central location and accessibility to various stakeholders, particularly those involved in HIV prevention efforts. The participants were purposefully selected to ensure diverse representations, including youth who are potential PrEP users, pharmacy providers, regulators, and representatives from civil society organizations. The meeting utilized the Nominal Group Technique (NGT)—a structured method for facilitating group decision-making and prioritizing ideas—to adapt the Kenyan pharmacy-delivered PrEP model for implementation in the Nigerian context. Mock role play was conducted to help participants understand the care pathway. The discussions culminated in identifying challenges and viable strategies for implementing the model in Nigeria. Results: The one-day stakeholder meeting on 9 October 2024 was attended by 20 participants from various sectors involved in HIV prevention services. Stakeholders expressed enthusiasm for pharmacy-based PrEP delivery while acknowledging challenges associated with clinic-based services, such as stigma, limited hours, and long wait times. The key recommendations included training pharmacy providers, increasing awareness, ensuring confidentiality, establishing referral linkages, and integrating program data into the Health Management Information System (HMIS) as well as ensuring commodity availability and access. To enhance the success of the pilot study, stakeholders proposed engaging a research assistant, forming a monitoring team, and submitting the results to the Pharmacy Council of Nigeria (PCN) for review. Conclusions: The identified challenges and strategies for implementing the model in Nigeria will inform the development of a refined pharmacy-delivered PrEP framework that is ready for pilot testing and potential scaling across the country. [ABSTRACT FROM AUTHOR]

Background: Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of anti-malarial medicine to children <5 years during high malaria transmission seasons. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa. However, it was not implemented in Uganda until April 2021, when the country began SMC in the highly malaria-endemic Kotido and Moroto Districts. This study assessed the effect of SMC on malaria incidence among children <5 years of age in Kotido and Moroto Districts. Methods: An interrupted time-series analysis was conducted using monthly national health data from the Uganda Ministry of Health District Health Information System 2. The monthly data for outpatient (uncomplicated) malaria among children <5 years was extracted for the 52 months before SMC implementation (Jan 2017–Apr 2021) and 8 months during SMC implementation (May–Dec 2021). The monthly incidence of uncomplicated malaria per 1000 children <5 years was computed before and during SMC implementation. Results: In Kotido District, malaria incidence was 693/1000 during SMC implementation period, compared to an expected 1216/1000 if SMC had not been implemented. The mean monthly malaria incidence was 87/1000, compared to an expected mean of 152/1000 if SMC had not been implemented. This represents a statistically significant mean monthly change of −65.4 (95% CI = −104.6, −26.2) malaria cases/1000 during SMC implementation, or a 43.0% decline. In Moroto District, malaria incidence was 713/1000 during SMC implementation period, compared to an expected 905/1000 if SMC had not been implemented. The mean monthly malaria incidence was 89/1000, compared to an expected 113/1000 if SMC had not been deployed. This represents a statistically significant mean monthly change of −24.0 (95% CI = −41.1, −6.8) malaria cases/1000 during SMC implementation, or a 21.2% decline. Conclusion: Implementation of SMC substantially reduced the incidence of uncomplicated malaria among children <5 years in Moroto and Kotido Districts. Scaling up SMC in other districts with high malaria transmission could reduce malaria on a large scale across Uganda. [ABSTRACT FROM AUTHOR]