Search

BackgroundText or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. ObjectiveThis study aims to evaluate the effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. MethodsIn 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. ResultsIn the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P

BackgroundA mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. ObjectiveWe investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. MethodsWe conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. ResultsApproximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. ConclusionsAlthough a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded.

Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model. Key words: primary care; general practitioners; pandemic; COVID-19 Ann Fam Med 2022;20:273-276. https://doi.org/10.1370/afm.2808, INTRODUCTION Primary care is the frontline of the health system and has a critical role in responding to pandemics and other health emergencies. (1,2) Experience in previous pandemics, however, has [...]

Background: Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. Methods: We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. Findings: Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. Conclusions: Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings. [ABSTRACT FROM AUTHOR]

BACKGROUND. Ebola virus (EBOV) causes periodic outbreaks of life-threatening EBOV disease in Africa. Historically, these outbreaks have been relatively small and geographically contained; however, the magnitude of the EBOV outbreak that began in 2014 in West Africa has been unprecedented. The aim of this study was to describe the viral kinetics of EBOV during this outbreak and identify factors that contribute to outbreak progression. METHODS. From July to December 2014, one laboratory in Sierra Leone processed over 2,700 patient samples for EBOV detection by quantitative PCR (qPCR). Viremia was measured following patient admission. Age, sex, and approximate time of symptom onset were also recorded for each patient. The data was analyzed using various mathematical models to find trends of potential interest. RESULTS. The analysis revealed a significant difference (P = 2.7 x [10.sup.-77]) between the initial viremia of survivors (4.02 [log.sub.10] genome equivalents [GEQ]/ml) and nonsurvivors (6.18 [log.sub.10] GEQ/ml). At the population level, patient viral loads were higher on average in July than in November, even when accounting for outcome and time since onset of symptoms. This decrease in viral loads temporally correlated with an increase in circulating EBOV-specific IgG antibodies among individuals who were suspected of being infected but shown to be negative for the virus by PCR. CONCLUSIONS. Our results indicate that initial viremia is associated with outcome of the individual and outbreak duration; therefore, care must be taken in planning clinical trials and interventions. Additional research in virus adaptation and the impacts of host factors on EBOV transmission and pathogenesis is needed., Introduction Ebola virus (EBOV) (1, 2) is one of the deadliest pathogens in existence. Infection of a suitable host results in EBOV disease (EVD), which is characterized by the onset [...]

Background: Health system performance indicators are widely used to assess primary healthcare (PHC) performance. Despite the numerous tools and some convergence on indicator criteria, there is not a clear understanding of the common features of indicator selection processes. We aimed to review the literature to identify papers that document indicator selection processes for health system performance indicators in PHC. Methods: We searched the online databases Scopus, Medline, and CINAHL, as well as the grey literature, without time restrictions, initially on July 31, 2019 followed by an update November 13, 2020. Empirical studies or reports were included if they described the selection of health system performance indicators or frameworks, that included PHC indicators. A combination of the process focused research question and qualitative analysis meant a quality appraisal tool or assessment of bias could not meaningfully be applied to assess individual studies. We undertook an inductive analysis based on potential indicator selection processes criteria, drawn from health system performance indicator appraisal tools reported in the literature. Results: We identified 16 503 records of which 28 were included in the review. Most studies used a descriptive case study design. We found no consistent variations between indicator selection processes of health systems of high income and low- or lower-middle income countries. Identified common features of selection processes for indicators in PHC include literature review or adaption of an existing framework as an initial step; a consensus building process with stakeholders; structuring indicators into categories; and indicator criteria focusing on validity and feasibility. The evidence around field testing with utility and consideration of reporting burden was less clear. Conclusion: Our findings highlight several characteristics of health system indicator selection processes. These features provide the groundwork to better understand how to value indicator selection processes in PHC. [ABSTRACT FROM AUTHOR]

Problem The World Health Organization (WHO) developed a guideline with 10 control measures to reduce transmission of A(H5N1) avian influenza virus in markets in low-resource settings. The practical aspects of guide implementation have never been described. Approach WHO's guideline was implemented in two Indonesian markets in the city of Makassar to try to reduce transmission of the A(H5N1) virus. The guideline was operationalized using a participatory approach to introduce a combination of infrastructural and behavioural changes. Local setting Avian influenza is endemic in birds in Makassar. Two of the city's 22 dilapidated, poorly-run bird markets were chosen for the study. Before the intervention, neither market was following any of WHO's 10 recommended control measures except for batch processing. Relevant changes Market stakeholders' knowledge about the avian influenza A(H5N1) virus improved after the interventions. WHO guideline recommendations for visual inspection, cleaning and poultry-holding practices, as well as infrastructural requirements for zoning and for water supply and utilities, began to conform to the WHO guideline. Low-maintenance solutions such as installation of wastewater treatment systems and economic incentives such as composting were well received and appropriate for the low-resource setting. Lessons learnt Combining infrastructural changes with behaviour change interventions was critical to guideline implementation. Despite initial resistance to behaviour change, the participatory approach involving monthly consultations and educational sessions facilitated the adoption of safe food-handling practices and sanitation. Market authorities assumed important leadership roles during the interventions and this helped shift attitudes towards regulation and market maintenance needs.This shift may enhance the sustainability of the interventions. [TEXT NOT REPRODUCIBLE IN ASCII.] Probleme L'Organisation mondiale de la Sante (OMS) a concu un guide avec 10 mesures de controle permettant de reduire la transmission du virus de la grippe aviaire A(H5N1) sur les marches a faibles ressources. Les aspects pratiques de l'application du guide n'ont jamais ete decrits. Approche Le guide de l'OMS a ete applique a deux marches indonesiens dans la ville de Makassar afin de tenter de reduire la transmission du virus A(H5N1). Le guide a ete utilise a l'aide d'une approche participative pour presenter une combinaison de changements infrastructurels et comportementaux. Environnement local La grippe aviaire est endemique chez les oiseaux a Makassar. Deux des 22 marches a oiseaux delabres et pauvres de la ville ont ete choisis pour l'etude. Avant l'intervention, aucun des deux marches ne suivait les 10 mesures de controle recommandees par l'OMS, a l'exception du traitement des lots. Changements significatifs Les connaissances des parties prenantes des marches sur le virus de la grippe aviaire A(H5N1) se sont ameliorees apres les interventions. Les recommandations du guide de l'OMS en matiere d'inspection visuelle, de nettoyage et de pratiques de conservation de la volaille, ainsi que les exigences infrastructurelles pour le zonage et pour les equipements et l'alimentation en eau ont commence a etre conformes au guide de l'OMS. Des solutions necessitant peu de maintenance, comme l'installation de systemes de traitement des eaux usees, ainsi que des incitations economiques comme le compostage ont ete bien accueillies et s'adaptaient parfaitement au systeme a faibles ressources. Lecons tirees Combiner les changements infrastructurels aux interventions de changements des comportements etait essentiel a l'application du guide. Malgre une premiere resistance au changement 'comportemental, l'approche participative impliquant des consultations mensuelles et des sessions de formation ont facilite l'adoption d'une hygiene publique et de pratiques de gestion d'une alimentation saine. Les autorites des marches ont joue un role de leader important lors des interventions, ce qui a aide a modifier les attitudes envers la reglementation et les besoins en maintenance des marches. Ce changement peut ameliorer la durabilite des interventions. [TEXT NOT REPRODUCIBLE IN ASCII.] Aplicacion de la guia para mercados de alimentos saludables en dos mercados indonesios con el fin de reducir la transmision de la <> Situacion La Organizacion Mundial de la Salud (OMS) desarrollo una guia con 10 medidas de control para reducir la transmision del virus de la gripe aviar A(H5N1) en mercados en entornos con escasez de recursos. Nunca se describieron los aspectos practicos de la aplicacion de dicha guia. Enfoque La guia de la OMS se aplico en dos mercados indonesios de la ciudad de Makassar con el fin de intentar reducir la transmision del virus A (H5N1). La guia se hizo mas funcional a traves un enfoque participativo para introducir una combinacion de cambios tanto en las infraestructuras como en los comportamientos. Marco regional La gripe aviar es endemica en las aves de Makassar. Para este estudio se eligieron dos de los 22 mercados de aves deteriorados y mal gestionados de la ciudad. Antes de la intervencion, ninguno de los dos mercados seguia ninguna de las 10 medidas de control recomendadas por la OMS, exceptuando la de procesamiento en lotes. Cambios importantes Tras la intervencion, se observo una mejora considerable de los conocimientos de los participantes en el mercado sobre el virus de la gripe aviar A (H5N1). Empezaron a aplicarse las recomendaciones de la guia de la OMS en cuanto a inspeccion visual, limpieza y practicas de explotacion avicola. Del mismo modo, los requisitos infraestructurales de distribucion en zonas, suministro de agua y servicios publicos empezaron a adherirse a la guia de la OMS. Las soluciones de bajo mantenimiento como la instalacion de sistemas de tratamiento de aguas residuales y los incentivos economicos como el del compostaje fueron bien recibidos y adecuados para este entorno con escasez de recursos. Lecciones aprendidas La combinacion de intervenciones para realizar cambios en las infraestructuras y en el comportamiento resulto fundamental en la puesta en practica de la guia. A pesarde la resistencia inicial a los cambios de comportamiento, el enfoque participativo con consultas mensuales y sesiones educativas facilito la adopcion de unas practicas seguras de manipulacion de alimentos y de saneamiento. Las autoridades competentes asumieron un importante rol de liderazgo durante las intervenciones, lo que ayudo a cambiar actitudes respecto a las necesidades de regulacion y de mantenimiento de los mercados. Este cambio podria potenciar la sostenibilidad de las intervenciones., Introduction Live bird markets have been implicated in the circulation of avian influenza A(H5N1) virus (1) and are a potential source of viral transmission among humans and animals. (2,3) In [...]

The emergence of pandemic influenza A (H1N1) 2009 in Mexico and the United States, with rapid spread to Europe, Asia, and the Pacific, is testament to the ease of spread [...]

Food markets that offer both poultry meat and live birds either for sale or for slaughter are collectively referred to as live-bird markets (LBMs). LBMs are part of the supply [...]