In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family ...planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines.
One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18-49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use.
849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively.
Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk ...burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).
Au cours de la dernière décennie dans l’ère des OMD (Objectifs du Millénaire pour le Développement), l’accent a été fortement mis sur la volonté d’atteindre les quintiles économiques inférieurs dans les pays à revenu faible et moyen. Toutefois, l’insistance démesurée mise sur l’allè- gement du risque financier, et sur l’accroissement de la prise en charge en l’absence d’un effort suffisant à fournir pour une meilleure qualité de services peut expliquer la lenteur de la progression des OMD dans de nombreux pays. Les Ressources Humaines pour la Santé sont à la base d’une meilleure qualité des prestations de service, mais elles restent t insuffisamment sollicitées dans les nombreuses stratégies mises en place par les pays avec pour objectif la Couverture de Santé Universelle. Sans les investissements appropriés pour améliorer et développer la formation dans les professions médicales, l’obtention et le maintien de progrès sont improbables. Le passage des Objectifs du Millénaire pour le Développement (MDG) aux Objectifs de Développement Durable (SDG), avec de nouvelles initiatives intéressantes, telles que la Facilité de Financement Mondiale, permet d’obtenir des gains substantiels dans la qualité des services offerts, et de valoriser les ressources dans la santé humaine. Cet effort devrait permettre à des méthodologies efficaces d’améliorer les compétences des travailleurs de la santé, et de changer les pratiques qui sont employées, en éliminant celles qui sont inefficaces et nuisibles (y compris l’influence injustifiée des intérêts commerciaux).
Durante la última década de los Objetivos de Desarrollo del Milenio (ODM) se presenció un enfoque sustancial en alcanzar a los quintiles económicos más bajos en los países de ingresos bajos y medios. Sin embargo, el enfoque excesivo en reducir la carga de riesgo financiero y en incrementar la cobertura sin suficiente atención a la expansión de la calidad del servicio, puede explicar el lento progreso de los ODMs en muchos países. Los Recursos Humanos para la Salud (RHS) forman la base de la calidad y de las mejoras del servicio, pero aún continúan sin ser abordados en muchas estrategias nacionales para obtener la Cobertura de Salud Universal. Sin la inversión requerida para mejorar y expandir la educación médica profesional, lograr y sostener mejorías es poco probable. La transición de los ODMs a los Objetivos de Desarrollo Sostenible (ODSs) con nuevas iniciativas vigorosas de financiamiento como al Facilidad Financiera Global tienen el potencial de crear mejoras sustanciales en la calidad de los servicios y de actualizar los recursos humanos de salud. Este enfoque debe garantizar que se usen metodologías efectivas para mejorar las aptitudes de los trabajadores de salud y para cambiar las prácticas, y que las metodologías ineficaces y dañinas sean eliminadas (incluyendo la influencia innecesaria del sector comercial.
千年发展目标的最后十年见证了就低收入与中等收入国家处 于经济底层的五分之一人口开展的大量重点工作。然而, 过 度关注降低财务风险负担及提高覆盖面, 却没有充分地关注扩 大服务质量, 可能会导致千年发展目标在部分国家的进展缓 慢。医疗服务方面的人力资源是改进服务质量与供给的基础, 但仍然在部分国家实现全民医疗覆盖的国家战略中处于未被 解决的状态。若没有足够的投资来改善和扩大医疗执业教育, 取得或维持成果则缺乏可能性。千年发展目标向可持续发展 目标转变, 并与诸如全球融资机制等激奋人心的新融资举措一 道, 会激发提升医疗服务质量和医疗人力资源水平的潜力。工 作应将重点放在确保有有效的方法来改善医疗工作者的能力, 变革就业实践, 淘汰无效及有害者（包括商业利益的不当影 响）。
The Omicron variant of severe acute respiratory syndrome coronavirus 2 caused the largest surge of coronavirus disease (COVID-19) cases in Japan starting in the summer of 2022. We describe the ...mechanisms introduced to provide appropriate health care to all Omicron cases, provide appropriate health care to all non-COVID-19 patients, and protect health-care workers (HCWs) while providing necessary health services. Optimization of care for elderly patients was particularly important.
Japan is home to 125 million people, of whom 28.6% are 65 years or older. Between January and June 2022, the country experienced 4.3 times more COVID-19 cases than in the previous 2 years (7.3 million vs 1.7 million).
To adjust care pathways, inpatient treatment capacity was increased, a home-based care system was established, and an on-site treatment scheme at long-term care facilities was started. Among essential health services, disruption of emergency care became most noticeable. Administrative and financial support was provided to hospitals with emergency departments to maintain emergency medical services. To protect HCWs while maintaining hospital services, flexible exemptions were introduced to enable those who became close contacts to return to work, and broadly targeted contact tracing and testing in case of nosocomial outbreaks were all helpful.
As a result of the adjustments made to inpatient capacity and patient flow, bed occupancy for COVID-19 patients decreased, mostly because many patients were cared for at home or in temporary-care facilities.
From this study, we extracted two essential lessons to aid in current and future health emergencies: how to balance the provision of acute medical care for elderly patients and maintain their well-being; and how to maintain essential health services.
Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to ...infection of the maternal genital tract during labour.
The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.
Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4-3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0-26.6) in Honduras to 3.6% (95% CI: 1.0-8.5) in Indonesia.
Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and ...development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO.
For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up.
Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments.
Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
STUDY QUESTION
What is the contribution of the underuse of modern methods (MM) of contraception to the annual undesired pregnancies in 35 low- and middle-income countries?
SUMMARY ANSWER
Fifteen ...million out of 16.7 million undesired pregnancies occurring annually in 35 countries could have been prevented with the optimal use of MM of contraception.
WHAT IS KNOWN ALREADY
Every year, 87 million women worldwide become pregnant unintentionally because of the underuse of MM of contraception.
STUDY DESIGN, SIZE, DURATION
Demographic and health surveys (DHS) of 35 countries, conducted between 2005 and 2012, were analysed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Contraceptive use of 12 874 unintentionally pregnant women was compared with 111 301 sexually active women who were neither pregnant nor desiring pregnancy.
MAIN RESULTS AND THE ROLE OF CHANCE
An average of 96% of 15- to 49-year-old eligible women took part in the survey. When adjusted for covariates and compared with the use of MM of contraception, the use of traditional methods was associated with a 2.7 95% confidence interval (CI): 2.3–3.4 times increase in odds of an undesired pregnancy, while non-use of any method was associated with a 14.3 (95% CI, 12.3–16.7) times increase. This corresponded to an estimated 16.7 million undesired pregnancies occurring annually in the 35 countries, of which 15.0 million could have been prevented with the optimal use of MM of contraception (13.5 million women did not use MM whilst 1.5 million women utilized MM incorrectly). Women with the lowest educational attainment and wealth quintile were 8.6 (95% CI: 8.2–9.1) and 2.6 (95% CI: 2.4–2.9) times less likely to use contraceptives compared with those with the highest level of each, respectively. Of the 14 893 women who neither desired pregnancy nor used contraception, 5559 (37.3%) cited fear of side effects and health concerns as the reason for non-use, 3331 (22.4%) cited they or their partner's opposition to contraception or religious prohibition and 2620 (17.6%) underestimated the risk of pregnancy.
LIMITATIONS, REASONS FOR CAUTION
Despite the fact that DHS are considered high-quality studies, we should not underestimate the role played by recall bias for past pregnancies. Few women report a current pregnancy in the first trimester and undesired pregnancies at that time are probably prone to under-reporting. Some terminated pregnancies may not be included in the current pregnancy group. Furthermore, covariates measured at the time of the survey may not have reflected the same covariates at the time the currently pregnant women became pregnant.
WIDER IMPLICATIONS OF THE FINDINGS
Underuse of MM of contraception burdens especially the poor and the less educated. National strategies should address unfounded health concerns, fear of side effects, opposition and underestimated risk of pregnancy, which are major contributors to undesired pregnancies.
FUNDING/CONFLICT(S) OF INTEREST
No external funding was utilized for this report. There are no conflicts of interest to declare.
The coronavirus disease (COVID-19) pandemic has transformed clinical practice and health systems. This paper provides an overview of COVID-19 clinical management and health-care pathway challenges ...that the World Health Organization and its Member States in the Western Pacific Region have faced. The experiences and lessons identified can help countries to better prepare for future pandemics.
This is a wide-ranging 2004 book about arguments for and against beliefs in God. The arguments for the belief are analysed in the first six chapters and include ontological arguments from Anselm to ...Gödel, the cosmological arguments of Aquinas and Leibniz, and arguments from evidence for design and miracles. The next two chapters consider arguments against belief. The last chapter examines Pascalian arguments for and against belief in God. There are discussions of Cantorian problems for omniscience, of challenges to divine omnipotence, and of the compatibility of everlasting complete knowledge of the world with free-will. There are appendices that present formal proofs in a system for quantified modal logic, a theory of possible worlds, notes on Cantorian set theory, and remarks concerning non-standard hyperreal numbers. This book will be a valuable resource for philosophers of religion and theologians and will interest logicians and mathematicians as well.
Objective
To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality.
Methods
The present secondary analysis included Demographic and ...Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees’ most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions—used as an indicator for having experienced eclampsia—and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality.
Results
The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval CI 1.0–1.3), 1.7% (95% CI 1.5–2.1), and 1.7% (95% CI 1.5–2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4–3.2).
Conclusion
Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions.
The incidence of eclampsia differed across the regions investigated. Convulsions indicative of eclampsia were associated with a two‐fold increased risk of early neonatal mortality.
Newborn mortality in Oceania declined slower than other regions in the past 25 years. The World Health Organization (WHO) introduced the Early Essential Newborn Care program (EENC) in 2015 in Solomon ...Islands, a Small Island Developing State, to address high newborn mortality. We explored knowledge and skills retention among healthcare workers following EENC coaching.
Between March 2015 and December 2017, healthcare workers in five hospitals were assessed: pre- and post-clinical coaching and at a later evaluation. Standardised written and clinical skills assessments for breathing and non-breathing baby scenarios were used. Additionally, written surveys were completed during evaluation for feedback on the EENC experience.
Fifty-three healthcare workers were included in the evaluation. Median time between initial coaching and evaluation was 21 months (IQR 18-26). Median written score increased from 44% at baseline to 89% post-coaching (p < 0.001), and was 61% at evaluation (p < 0.001). Skills assessment score was 20% at baseline and 95% post-coaching in the Breathing Baby scenario (p < 0.001). In the Non-Breathing Baby scenario, score was 63% at baseline and 86% post-coaching (p < 0.001). At evaluation, median score in the Breathing Baby scenario was 82% a reduction of 13% from post-coaching (p < 0.001) and 72% for the Non-Breathing Baby, a reduction of 14% post-coaching (p < 0.001). Nurse aides had least reduction in evaluation scores of - 2% for the Breathing Baby and midwives - 10% for the Non-Breathing Baby respectively from post-coaching to evaluation.
EENC coaching resulted in immediate improvements in knowledge and skills but declined over time. Healthcare workers who used the skills in regular practice had higher scores. Complementary quality improvement strategies are needed to sustain resuscitation skills following training over time.
Australia New Zealand Trial Registry, Retrospective Registration (12/2/2019), registration number ACTRN12619000201178.
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