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INTRODUCTION: Malawi is rapidly closing the gap in achieving the UNAIDS 95-95-95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low-cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility-based HIV testing modalities and determine the most cost-effective strategy to increase the proportion of men and youth testing for HIV. METHODS: A data-driven individual-based model was parameterized with data from a community-representative survey (socio-demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self-testing (HIVST) and provider-initiated-testing-and-counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12-month period, cost-effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios. RESULTS: Facility-based HIVST offered year-round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%-83%), was considered cost-saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year-round HIVST in the OPD remained on the cost-effectiveness frontier. CONCLUSIONS: Facility-based HIVST is a cost-effective strategy to increase the proportion of men/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD-providing additional healthcare worker time for other priority healthcare activities.

Objectives Optimising antibiotic use in healthcare settings through antimicrobial stewardship programmes (ASPs) is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antimicrobial resistance. This needs assessment was designed to provide the current status of ASPs in healthcare facilities in Lagos State and identify gaps for future interventions. Methods A descriptive cross-sectional survey was conducted using a self-administered questionnaire to ascertain the extent and nature of ongoing ASPs among selected healthcare facilities and identify gaps for future interventional studies. Results Of 32 questionnaires distributed, 25 (78%) were completed and returned from three tertiary, six secondary, eleven primary and five private healthcare facilities. The mean years of practice of respondents was 13.96 ± 7.8 years (2–31 years). Six facilities (24%) had a team responsible for ASP operating at varying degrees of capacity, while five (20%) had a formal ASP. All six facilities with an antimicrobial stewardship (AMS) team had a medical doctor as the team lead, and 5 (20%) also had a pharmacist involved in implementation efforts. Routine pre-authorisation for specific antibiotic was performed in six facilities (24%), four of which monitor pre-authorisation interventions. Only two facilities (8%) performed prospective audit and feedback for specific antibiotic agents. Private healthcare facilities were more likely to have information technology (IT) capability to support the needs of AMS activities. Conclusion This study revealed minimal ASP activities in healthcare facilities in Lagos State and highlighted possibilities of leveraging on available IT resources for a co-ordinated AMS strategy.

Background Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. Methods A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Conclusions Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

Objective The spread of coronavirus disease 2019 (COVID-19) has led to severe strain on hospital capacity in many countries. We aim to develop a model helping planners assess expected COVID-19 hospital resource utilization based on individual patient characteristics. Materials and Methods We develop a model of patient clinical course based on an advanced multistate survival model. The model predicts the patient's disease course in terms of clinical states—critical, severe, or moderate. The model also predicts hospital utilization on the level of entire hospitals or healthcare systems. We cross-validated the model using a nationwide registry following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1 to May 2, 2020 (n = 2703). Results Per-day mean absolute errors for predicted total and critical care hospital bed utilization were 4.72 ± 1.07 and 1.68 ± 0.40, respectively, over cohorts of 330 hospitalized patients; areas under the curve for prediction of critical illness and in-hospital mortality were 0.88 ± 0.04 and 0.96 ± 0.04, respectively. We further present the impact of patient influx scenarios on day-by-day healthcare system utilization. We provide an accompanying R software package. Discussion The proposed model accurately predicts total and critical care hospital utilization. The model enables evaluating impacts of patient influx scenarios on utilization, accounting for the state of currently hospitalized patients and characteristics of incoming patients. We show that accurate hospital load predictions were possible using only a patient’s age, sex, and day-by-day clinical state (critical, severe, or moderate). Conclusions The multistate model we develop is a powerful tool for predicting individual-level patient outcomes and hospital-level utilization.

The COVID-19 pandemic revealed many vulnerabilities of the contemporary built environment along with limited preparedness and low efficiency in mitigating unexpected and unprecedented challenges. This article discusses the efficiency and responsiveness of basic hospital spatial layouts in three different scenarios: normal operation; the segregation of a large number of patients and still providing them with access to emergency healthcare, typical for a pandemic; and a sudden, extremely high number of admissions typical for compound disasters and terrorist attacks. A set of parameters and a method for general adaptability assessment (GAAT) that can be used as a tool in decision-making processes as well as evaluation of both existing facilities and the new models for resilient hospitals resulting from the experience of the pandemic are proposed. The paper emphasizes why factors among which adaptability, convertibility, and scalability should be at the very core of hospital development and management strategies. It also discusses new models of adaptable healthcare facilities that enable day-to-day operations to continue alongside a pandemic, and other emergency scenarios.

The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks’ workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels.

Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28–34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.

Aim The study assessed the return for prenatal care and childbirth services among Nigerian women using primary health care facilities. Design A descriptive cross‐sectional approach was employed for the study. Methods A total of 730 participants randomly recruited systematically from 21 purposively selected primary health care facilities in Ibadan, Nigeria were studied. A questionnaire and a checklist were used for data collection. The collection of data spanned three months (April to June, 2014). The data were analysed descriptively and inferentially while the results were presented in frequency tables. Results The women's mean age was 28 ± 5.3 years. Out of the 730 women studied, 92.6% received prenatal care. The mean difference between the number of prenatal care registration and the number of childbirths was 76.5. Poor environmental hygiene of facilities, statistically significant cost of services and non‐availability of 24‐hr service were implicated for dissatisfaction with care received by the women and consequent poor return rate for childbirth.

Background: Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. Aim: The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. Design: This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). Data sources: An iterative literature search was conducted over 2 years (2015–2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. Results: Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context–mechanism–outcome configurations in four conceptual areas: (1) family adaptation, (2) the child’s situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the ‘expert’ child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. Conclusion: Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.

There is increasing evidence that indoor air quality and contaminated surfaces provide an important potential source for transmission of pathogens in hospitals. Airborne hospital microorganisms are apparently harmless to healthy people. Nevertheless, healthcare settings are characterized by different environmental critical conditions and high infective risk, mainly due to the compromised immunologic conditions of the patients that make them more vulnerable to infections. Thus, spread, survival and persistence of microbial communities are important factors in hospital environments affecting health of inpatients as well as of medical and nursing staff. In this paper, airborne and aerosolized microorganisms and their presence in hospital environments are taken into consideration, and the factors that collectively contribute to defining the infection risk in these facilities are illustrated.

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.

The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.

Background Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming. Methods A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%). Conclusions Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Background Worldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, particularly healthcare services. We aimed to explore the healthcare opportunities available to them, using patterns of healthcare utilization and difficulties faced by DSD population in accessing healthcare services in Bangladesh. Methods Data from a total of 945 DSD population and 71 medical staff were analyzed, collected from three major divisions (Dhaka, Chittagong, and Rajshahi) in Bangladesh during the period of January to December of 2017. A structured questionnaire was used to collect data via face-to-face interviews. Descriptive statistic was used to determine the frequencies of the visit by the DSD population in healthcare facilities as well as to analyze difficulties experienced by the DSD population in getting healthcare services. Multivariate regression analysis was used to explore the association between perceived barriers in getting healthcare services and failures of the DSD population to receive the healthcare services. Results Present data revealed that around 80% of DSD population sought healthcare services from government healthcare facilities, where the overall success rate in getting healthcare services was less than 50%. The DSD population reported a number of reasons for failures in getting healthcare services, including non-friendly interaction by non-clinical hospital’s staff, non-friendly interaction by physicians, public fright as general people do not want to mingle with a DSD person, undesirable excess public interest in DSD individuals, and limitation of the treatment opportunities of hospitals to merely male or female patients. Among the stated reasons, the most frequently reported reason was non-friendly interaction by physicians (50.27%), followed by undesirable excess public interest in DSD individuals (50.16%). Conclusion DSD population in Bangladesh have limited access to healthcare facilities and facing multiple barriers to get healthcare services. Initiatives from the government and social organizations are important to ensure their access to healthcare services.

Background: In the past decade, Yemen has witnessed several disasters that resulted in a crumbled healthcare system. With the declaration of COVID-19 a global pandemic, and later the appearance of first confirmed cases in Yemen, there is an urgent need to assess the preparedness of healthcare facilities (HCFs) and their capacities to tackle a looming COVID-19 outbreak. Herein, we present an assessment of the current state of preparedness and capabilities of HCFs in Yemen to prevent and manage the COVID-19 outbreak. Methods: An online survey for HCFs was developed, validated, and distributed. The questionnaire is divided into five main sections: (1) Demographic variables for participants. (2) HCFs capabilities for COVID-19 outbreak. (3) Support received to face the emergence and spread of COVID-19. (4). Current practices of infection prevention and control measures in the HCFs. The last section focused on the recommendations to ensure effective and timely response to this outbreak in Yemen. Descriptive analysis was used to analyze data using statistical package for social sciences (SPSS), version 23. Results: Responses were received from healthcare workers (HCWs) from 18 out of 22 governorates in Yemen. Out of the 296 HCWs who participated in the study, the vast majority (93.9%) believed that the healthcare system in Yemen does not have the resources and capabilities to face and manage a COVID-19 outbreak. Approximately 82.4% of participants rated the general preparedness level of their HCFs as very poor or poor. More specifically, the majority of HCWs rated their HCFs as very poor or poor in term of availability of the following: an adequate number of mechanical ventilators (88.8%), diagnostic devices (88.2%), ICU rooms and beds (81.4%), and isolation rooms (79.7%). Conclusions: The healthcare facilities in Yemen are unprepared and lack the most basic resources and capabilities to cope with or tackle a COVID-19 outbreak. With the current state of a fragile healthcare system, a widespread outbreak of COVID-19 in Yemen could result in devastating consequences. There is an urgent need to provide support to the healthcare workers and HCFs that are on the frontline against COVID-19.

Introduction. Indoor air quality is one the main issues in which governments are focusing. In healing spaces, several research studies are reporting a growing number of data analysis and research works in order to guarantee and prevent health of users and workers. Currently the main investigations are about biological and physical risks; otherwise chemical ones are less investigated. Several countries are carrying out indoor air quality monitoring in those professional workplaces in which chemicals are used but also in some typically indoor (generic) spaces for the building hygiene assessment. The indoor air is affected by several factors that currently are analyzed punctually, without a whole scenario of all the variable performances. The authors have done a systematic review on the current state of the art and knowledge related to chemical pollution in healing spaces and the emerging strategies, supported by scientific literature, for healthy inpatient rooms and their indoor air.Methodology. The systematic review has been done through the analysis of papers from SCOPUS, DOAJ, and PubMed databases. The survey sample considered 483 scientific articles, between 1989 and 2017, and starting the systematic reading and analysis of the abstracts, only 187 scientific papers were selected, and only 96 were accessible.Discussion. Since scientific literature reports very different outputs and results, the resulting work from the survey is divided into specific fields of interest related to construction and finishing materials, installations, components, ventilation systems, processes, etc. Starting from the systematic reading, the paper classifies the factors of indoor air in four macroareas: outdoor air and microclimatic factors (temperature, relative humidity, air velocity, air change, etc.); management activities (management and maintenance activities, ventilation systems, HVAC, cleaning and disinfectant activities, etc.); design factors (room dimensions, furniture, finishing materials, etc.); and human presence and medical activities (users’ presence, their health status, and medical activities carried out in inpatient rooms).Conclusion. The systematic review gives rise to a broad scenario on the existing knowledge regarding the indoor air pollution, design, and management strategies for healthy spaces and several emerging topics. Although the aim of the investigation is strictly related to chemical pollution, several considerations from the biological point of view have been listed. The systematic review, supported by the existing scientific literature, becomes a starting point for considering the importance of the topic and to stimulate the knowledge around this field of interest for improving studies, analysis, and simulations.

Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.

Background Ghana is implementing activities towards universal health coverage (UHC) as well as the attainment of the health-related Sustainable Development Goals (SDGs) by the health sector by the year 2030. Aside lack of empirical forecast of the required healthcare facilities to achieve these mandates, health workforce deficits are also a major threat. We therefore modelled the needed healthcare facilities in Ghana and translated it into year-by-year staffing requirements based on established staffing standards. Methods Two levels of modelling were used. First, a predictive model based on Markov processes was used to estimate the future healthcare facilities needed in Ghana. Second, the projected healthcare facilities were translated into aggregate staffing requirements using staffing standards developed by Ghana’s Ministry of Health (MoH). Results The forecast shows a need to expand the number/capacity of healthcare facilities in order to attain UHC. All things being equal, the requisite healthcare infrastructure for UHC would be attainable from 2023. The forecast also shows wide variations in staffing-need-availability rate, ranging from 15% to 94% (average being 68%) across the various staff types. Thus, there are serious shortages of staff which are worse amongst specialists. Conclusion Ghana needs to expand and/or increase the number of healthcare facilities to facilitate the attainment of UHC. Also, only about 68% of the health workforce (HWF) requirements are employed and available for service delivery, leaving serious shortages of the essential health professionals. Immediate recruitment of unemployed but qualified health workers is therefore imperative. Also, addressing health worker productivity, equitable distribution of existing workers, and attrition may be the immediate steps to take whilst a long-term commitment to comprehensively address HWF challenges, including recruitments, expansion and streamlining of HWF training, is pursued.

Access to healthcare facilities is an essential measure of the urban development of contemporary cities. Governments often budget huge sums to fulfill the healthcare demands of the population, however neglect to address requirements specific to women. This paper assesses the density, spatial distribution, and services of healthcare facilities to identify care requirements specific to women, and how their needs are—or could be—met. The analysis addresses the research question: What strategies will improve women’s access to healthcare and satisfy their healthcare requirements? Methods include a case study in the Yuetan Area of Beijing, field investigation, mapping, and questionnaires. The survey was carried out in November 2021 and January 2022 and involved 462 women residents in the Yuetan Area. Results indicate: (i) that, despite the total number of facilities meeting the standards recommended by the WHO, the spatial distribution of healthcare facilities is imbalanced; (ii) women’s healthcare encompasses both physical and psychological health. Optimizing accessibility to healthcare facilities can positively impact women’s health and well-being. Conclusions include insights regarding the relationship between access to healthcare facilities women’s healthcare requirements, as well as proposing strategies for improved healthcare facilities with a focus on an equitable and sympathetic society.

Background Dog bites are common in developing countries including Ghana, with the victims often being children. Although some breeds of dogs have been identified as being more aggressive than others, all dog bites carry a risk of infection. Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites. This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region, Ghana. Methods We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015. Up to four frontline service providers were randomly selected to participate from each facility. A structured questionnaire was administered to all consenting participants. Continuous variables were presented as means and standard deviations. The frontline service providers’ knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions. The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies. Results Regarding the frontline service providers’ knowledge about rabies, 57.8% (134/232) were correct in that the rabies virus is the causative agent of rabies, 39.2% (91/232) attributed it to a dog bite, 2.6% (6/232) did not know the cause, and one person (0.4%) attributed it to the herpes virus. Only 15.5% (36/232) knew the incubation period in dogs and the period required to observe for signs of a rabies infection. With respect to the administration of rabies immunoglobulin, 42.2% (98/232) of the frontline service providers did not know how to administer it. Of the facilities visited, 76% (50/66) did not have the rabies vaccines and 44% (102/232) of frontline service providers did not know where to get the rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies. Overall, there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana. Conclusions In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers, there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection. Electronic supplementary material The online version of this article (10.1186/s40249-018-0398-3) contains supplementary material, which is available to authorized users.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.

Medical facilities, while providing both essential and demanding health care to society’s most vulnerable populations, also belong to the most demanding category of risk to human life if and when a crisis event occurs within its walls. The development of a safe evacuation plan for these facilities is extremely complicated, as the evacuation of medical facilities is much more complex than for other critical infrastructure. In this category, the evacuated patients constitute a specific risk group requiring specialized medical care. Hospitalized persons may be dependent on life-saving measures, are unconscious or immobile, are significantly restricted in movement or mentally unbalanced, being dependent on the continued assistance of trained third parties. Additionally, the medical transport of evacuated patients becomes more difficult due to the limited capacity of ambulances and available health care facilities to transport them to, which are increasingly limited due to their overcrowded census. The study aimed to analyze the requirements which are placed on hospitals in Poland to ensure the safety of patients in case of an evacuation. The research method used in the paper was retrospective analysis and evaluation of the media and literature. We have found, that Polish law imposes an obligation on the administrator of a medical facility to ensure the safety of both patients and employees. The regulations cover issues of technical conditions to be met by buildings and their location, prevention, and fire protection requirements, and the determination of which staff is responsible for the evacuation. However, available documents fail to describe what the hospital evacuation process itself should entail under emergency evacuation. Taking into account the complexity of the hospital evacuation process, health care facilities should have a well-developed plan of action that must be implemented at least once a year in the form of facility-wide training. Evacuation drills should not be avoided. Only trained procedures offer the possibility of later analysis to identify and eliminate errors and provide the opportunity to acquire skill sets and habits which promote the behaviors expected in real-life emergencies.

Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

Contains fulltext : 219886.pdf (Publisher’s version ) (Open Access) Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.Objectives: This paper describes and analyses the health systems of Algeria, Kuwait, Morocco, Saudi Arabia, Jordan and Iraq to PHC.Methods: Data were collected during a workshop at the Wonca East Mediterranean Regional Conference in 2018. Academic family physicians (FP) presented their country; using the Wonca framework of 11 PowerPoint slides, with queries of the country demographics, main health challenges, and the position of PHC in the health system.Results: The six countries had achieved a significant improvement in populations' health but currently face challenges of health financing, a small number of certified FPs, difficulties in accessing services and bureaucratic procedures. Primary concerns were the absence of a family practice model, brain drain and immigration of FPs. Countries differed in building a coherent policy.Conclusion: Priorities should be focused on: developing PHC model in Eastern Mediterranean region with advocacy for community-based PHC to policymakers; capacity building for strengthening PHC-oriented health systems with FP specialty training and restrict practising to fully trained FPs; engage communities to improve understanding of PHC; adopt quality and accreditation policies for better services; validation of the referral and follow-up process; and, develop public-private partnership mechanisms to enhance PHC for UHC.

Background and aim: The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals. Methods: The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020. Results: In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation. Conclusions: Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed to validate the strategies empirically. (www.actabiomedica.it)

Background While there has been a trend for greater number of women to deliver at health facilities across Tanzania, mothers and their family members continue to face mistreatment with respectful maternity care during childbirth being violated. The objective of this study was to describe the experience of mothers and fathers in relation to (mis) treatment during childbirth in Tanzania. Methods Using a qualitative descriptive design, 12 semi-structured interviews and four focus group discussions were held with mothers and fathers who were attending a postnatal clinic in the Lake Zone region of Tanzania. Mothers’ age ranged from 20 to 45 years whereas fathers’ age ranged from 25 to 60 years. Data were analyzed using a priori coding based on Bohren’s et al. typology of the mistreatment of women during childbirth. Results Mothers reported facing mistreatment and disrespectful maternity care through verbal abuse (harsh or rude language and judgmental or accusatory comments), failure to meet professional standards of care (refused pain relief, unconsented surgical operations, neglect, abandonment or long delays, and skilled attendant absent at time of delivery), poor rapport between women and providers (poor communication, lack of supportive care, denied husbands presence at birth, denied mobility, denied safe traditional practices, no respect for their preferred birth positions), and health system conditions and constraints (poor physical condition of facilities, supply constraints, bribery and extortion, unclear fee structures). Despite some poor care, some mothers also reported positive birthing experiences and respectful maternity care by having a skilled attendant assistance at delivery, having good communication from nurses, receiving supportive care from nurses and privacy during delivery. Conclusion Despite the increasing number of deliveries occurring in the hospital, there continue to be challenges in providing respectful maternity care. Humanizing birth care in Tanzania continues to have a long way to go, however, there is evidence that changes are occurring as mothers notice and report positive changes in delivery care practices. Electronic supplementary material The online version of this article (10.1186/s12884-019-2385-5) contains supplementary material, which is available to authorized users.

Pseudomonas aeruginosa is an opportunistic bacterial pathogen that is widely occurring in the environment and is recognized for its capacity to form or join biofilms. The present review consolidates current knowledge on P. aeruginosa ecology and its implication in healthcare facilities premise plumbing. The adaptability of P. aeruginosa and its capacity to integrate the biofilm from the faucet and the drain highlight the role premise plumbing devices can play in promoting growth and persistence. A meta‐analysis of P. aeruginosa prevalence in faucets (manual and electronic) and drains reveals the large variation in device positivity reported and suggest the high variability in the sampling approach and context as the main reason for this variation. The effects of the operating conditions that prevail within water distribution systems (disinfection, temperature, and hydraulic regime) on the persistence of P. aeruginosa are summarized. As a result from the review, recommendations for proactive control measures of water contamination by P. aeruginosa are presented. A better understanding of the ecology of P. aeruginosa and key influencing factors in premise plumbing are essential to identify culprit areas and implement effective control measures.

Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

This article provides a set of recommendations, selected from the systematic literature review carried out, regarding signage systems for healthcare institutions that can be used for designing or redesigning more competent signage systems. The signage systems in healthcare settings are usually poorly designed due to the expansion of the original facilities, a lack of awareness of existing guidelines by the developers, and a lack of agreement between the existing recommendations. There are several guidelines and recommendations available in the literature; however, each work was developed for specific cultural contexts, so there is a lack of uniformity among them. Hence, there is a need to uniformize the guidelines for signage design in healthcare, in order to provide supportive information for developers to build and implement effective and efficient signage systems. This study examined the available literature on the subject and established a set of guidelines organized in categories to help the design process. A literature review was conducted, and 34 selected publications were analyzed from which recommendations were created. A best practices manual was also studied and used as the analytical framework to establish the design categories of the developed recommendations. This review resulted in guidelines divided into nine design categories that should be considered in the design and implementation process of signage systems in healthcare facilities.

Graphical abstract, Highlights • 4 million patients in the EU acquire a healthcare associated infection each year. • Public spaces and other highly occupied spaces are implicated in infection outbreak. • Surfaces are one of the major factors contributing to these patterns of infection. • Guidelines for microbiological assessment in these scenarios are scarce. • Self-disinfecting surfaces are an emergent technology to control infection., According to World Health Organization, every year in the European Union, 4 million patients acquire a healthcare associated infection. Even though some microorganisms represent no threat to healthy people, hospitals harbor different levels of immunocompetent individuals, namely patients receiving immunosuppressors, with previous infections, or those with extremes of age (young children and elderly), requiring the implementation of effective control measures. Public spaces have also been found an important source of infectious disease outbreaks due to poor or none infection control measures applied. In both places, surfaces play a major role on microorganisms’ propagation, yet they are very often neglected, with very few guidelines about efficient cleaning measures and microbiological assessment available. To overcome surface contamination problems, new strategies are being designed to limit the microorganisms’ ability to survive over surfaces and materials. Surface modification and/or functionalization to prevent contamination is a hot-topic of research and several different approaches have been developed lately. Surfaces with anti-adhesive properties, with incorporated antimicrobial substances or modified with biological active metals are some of the strategies recently proposed. This review intends to summarize the problems associated with contaminated surfaces and their importance on infection spreading, and to present some of the strategies developed to prevent this public health problem, namely some already being commercialized.

On 30 October 2017, an outbreak of measles started in the Nouvelle-Aquitaine (NA) region in France among Bordeaux University students before spreading to other regions. Until 1 July 2018, 1,101 cases were reported in NA, including 98 complications and two deaths. Cases were related to clusters (e.g. students, healthcare workers) in 16%; 81% of cases were not vaccinated against measles as recommended. Vaccination coverage above herd immunity threshold remains the main preventative outbreak measure.

Background Large geographical variations in the intensity of the HIV epidemic in sub-Saharan Africa call for geographically targeted resource allocation where burdens are greatest. However, data available for mapping the geographic variability of HIV prevalence and detecting HIV ‘hotspots’ is scarce, and population-based surveillance data are not always available. Here, we evaluated the viability of using clinic-based HIV prevalence data to measure the spatial variability of HIV in South Africa and Tanzania. Methods Population-based and clinic-based HIV data from a small HIV hyper-endemic rural community in South Africa as well as for the country of Tanzania were used to map smoothed HIV prevalence using kernel interpolation techniques. Spatial variables were included in clinic-based models using co-kriging methods to assess whether cofactors improve clinic-based spatial HIV prevalence predictions. Clinic- and population-based smoothed prevalence maps were compared using partial rank correlation coefficients and residual local indicators of spatial autocorrelation. Results Routinely-collected clinic-based data captured most of the geographical heterogeneity described by population-based data but failed to detect some pockets of high prevalence. Analyses indicated that clinic-based data could accurately predict the spatial location of so-called HIV ‘hotspots’ in > 50% of the high HIV burden areas. Conclusion Clinic-based data can be used to accurately map the broad spatial structure of HIV prevalence and to identify most of the areas where the burden of the infection is concentrated (HIV ‘hotspots’). Where population-based data are not available, HIV data collected from health facilities may provide a second-best option to generate valid spatial prevalence estimates for geographical targeting and resource allocation. Electronic supplementary material The online version of this article (10.1186/s12942-018-0146-8) contains supplementary material, which is available to authorized users.

There is limited knowledge on the effect of seasonal flooding on health over time. We quantified the short- and long-term effects of floods on selected health indicators at public healthcare facilities in 11 districts in Cambodia, a flood-prone setting. Counts of inpatient discharge diagnoses and outpatient consultations for diarrhea, acute respiratory infections, skin infections, injuries, noncommunicable diseases and vector-borne diseases were retrieved from public healthcare facilities for each month between January 2008 and December 2013. Flood water was mapped by month, in square kilometers, from satellite data. Poisson regression models with three lag months were constructed for the health problems in each district, controlled for seasonality and long-term trends. During times of flooding and three months after, there were small to moderate increases in visits to healthcare facilities for skin infections, acute respiratory infections, and diarrhea, while no association was seen at one to two months. The associations were small to moderate, and a few of our results were significant. We observed increases in care seeking for diarrhea, skin infections, and acute respiratory infections following floods, but the associations are uncertain. Additional research on previous exposure to flooding, using community- and facility-based data, would help identify expected health risks after floods in flood-prone settings.

Background Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. Methods A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. Results The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Conclusions Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

Background WHO and UNICEF have proposed an action plan to achieve universal water, sanitation and hygiene (WASH) coverage in healthcare facilities (HCFs) by 2030. The WASH targets and indicators for HCFs include: an improved water source on the premises accessible to all users, basic sanitation facilities, a hand washing facility with soap and water at all sanitation facilities and patient care areas. To establish viable targets for WASH in HCFs, investigation beyond ‘access’ is needed to address the state of WASH infrastructure and service provision. Patient and caregiver use of WASH services is largely unaddressed in previous studies despite being critical for infection control. Methods The state of WASH services used by staff, patients and caregivers was assessed in 17 rural HCFs in Rwanda. Site selection was non-random and predicated upon piped water and power supply. Direct observation and semi-structured interviews assessed drinking water treatment, presence and condition of sanitation facilities, provision of soap and water, and WASH-related maintenance and record keeping. Samples were collected from water sources and treated drinking water containers and analyzed for total coliforms, E. coli, and chlorine residual. Results Drinking water treatment was reported at 15 of 17 sites. Three of 18 drinking water samples collected met the WHO guideline for free chlorine residual of >0.2 mg/l, 6 of 16 drinking water samples analyzed for total coliforms met the WHO guideline of

BACKGROUND: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure.METHODS: We analysed the impact of travel time to key healthcare facilities and mainland/island residency on the cancer diagnostic pathway (treatment within 62 days of referral, and within 31 days of diagnosis) and 1-year mortality using a data-linkage study with 12 339 patients.RESULTS: After controlling for important confounders, mainland patients with more than 60 min of travelling time to their cancer treatment centre ((OR 1.42; 95% CI 1.25-1.61) and island dwellers (OR 1.32; 95% CI 1.09-1.59) were more likely to commence cancer treatment within 62 days of general practitioner (GP) referral and within 31 days of their cancer diagnosis compared with those living within 15 min. Island-dweller patients were more likely to have their diagnosis and treatment started on the same or next day (OR 1.72; 95% CI 1.31-2.25). Increased travelling time to a cancer treatment centre was associated with increased mortality to 1 year (30-59 min (HR 1.21; 95% CI 1.05-1.41), >60 min (HR 1.18; 95% CI 1.03-1.36), island dweller (HR 1.17; 95% CI 0.97-1.41).CONCLUSIONS: Island dwelling and greater mainland travel burden was associated with more rapid cancer diagnosis and treatment following GP referral even after adjustment for advanced disease; however, these patients also experienced a survival disadvantage compared with those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.British Journal of Cancer advance online publication, 22 June 2017; doi:10.1038/bjc.2017.180 www.bjcancer.com.

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.

The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

Summary Isolation of patients with highly infectious diseases (HIDs) in hospital rooms with adequate technical facilities is essential to reduce the risk of spreading disease. The European Network for Infectious Diseases (EUNID), a project co-funded by European Commission and involving 16 European Union member states, performed an inventory of high level isolation rooms (HIRs, hospital rooms with negative pressure and anteroom). In participating countries, HIRs are available in at least 211 hospitals, with at least 1789 hospital beds. The adequacy of this number is not known and will depend on prevailing circumstances. Sporadic HID cases can be managed in the available HIRs. HIRs could also have a role in the initial phases of an influenza pandemic. However, large outbreaks due to natural or to bioterrorist events will need management strategies involving healthcare facilities other than HIRs.

The Taiwan Department of Health requested assistance from the Centers for Disease Control and Prevention (CDC) in controlling an outbreak of severe acute respiratory syndrome (SARS). The CDC SARS response team included industrial hygiene specialists from the National Institute for Occupational Safety and Health (NIOSH). Four NIOSH specialists visited hospitals and medical centers throughout Taiwan and assisted with designing and evaluating ventilation modifications for infection control, developed guidelines for converting hospital rooms into SARS patient isolation rooms, prepared designs for the rapid conversion of a vacated military facility into a SARS screening and observation facility, assessed environmental aspects of dedicated SARS hospitals, and worked in concert with the Taiwanese to develop hospital ventilation guidelines. We describe the environmental findings and observations from this response, including the rapid reconfiguration of medical facilities during a national health emergency, and discuss environmental challenges should SARS or a SARS-like virus emerge again.

Purpose: The reproductive health needs of unmarried adolescents in Bangladesh are largely unmet. This study aimed to explore treatment-seeking behaviour of unmarried female adolescents for selected reproductive health (RH) concerns in two low-performing areas of Bangladesh. Methods: As part of a large community based-project, a cross-sectional survey was conducted from November 2006 to March 2007. From each of two select study areas, 800 unmarried female adolescents aged 12–19 years were selected for participation by simple random sampling through household listing and were recruited into the study. Trained interviewers administered a structured questionnaire to participating female adolescents. Descriptive and bivariate analytic methods were used compare RH conditions and healthcare seeking behaviour of adolescents across urban and rural settings. Results: Approximately 50% of the sample reported experiencing menstrual problems in the last year. The predominant problems reported by participants included: lower abdominal pain, back pain, irregular menstruation, and excessive bleeding during menstruation. Irrespective of study area, only 40% of the female adolescents with menstrual problems sought treatment from qualified physicians. Otherwise, utilization of healthcare facilities and care providers for reported problems varied significantly by rural and urban areas. Higher proportions of adolescents in the urban setting (15%) also reported recent symptoms of sexually transmitted infections (STIs), compared to those in the rural setting (9%; p < 0.001). Across sites, however, self-treatment was the most commonly reported method of care for those who experienced any symptoms of STI. Conclusions: In general, treatment-seeking behaviours by unmarried female adolescents was low for menstrual problems. A vast majority of unmarried female adolescents practiced self-care for symptoms of STIs while only small proportions sought treatment from qualified physicians. These findings emphasize the need for offering relevant information on RH issues and introducing confidential adolescent-friendly reproductive healthcare facilities to enable unmarried female adolescents access to RH services when necessary.