BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confid...BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.展开更多
<p align="justify"> <span style="font-family:Verdana;">Background: Malaria is one of the main health problems in Yemen. Health education is essential for the control of diseases such as...<p align="justify"> <span style="font-family:Verdana;">Background: Malaria is one of the main health problems in Yemen. Health education is essential for the control of diseases such as malaria. School-age children represent 25% of Yemen’s population. Schools children can convey the knowledge and skills that they acquire at school to the community, thus increasing general community awareness about malaria. Aim to determine the impact of school-based malaria education intervention on knowledge, attitude and practice of school children towards malaria prevention and control. Methods: We conducted a community-based trial, intervention and non-intervention comparison (exposed & non-exposed), in four randomly selected districts (rural and urban) of Taiz governorate. This study was conducted in four districts of Taiz governorate. The study population was 2130 pupils of grade 6, 7, and 8 in primary schools, chosen from four randomly selected districts;two of them were rural and the others urban. Four schools and their pupils (1065 pupils) were chosen for the study and assigned as an intervention group and four schools with their pupils (1065) were chosen for the study and assigned as a non-intervention (1065 pupils). Data were collected using questioner in intervention and non-intervention schools (three months apart). The major intervention activities included lectures about malaria, distribution of educational materials. χ<sup>2</sup> was used to analyze differences. Results: Health education activities in schools were associated with the increased knowledge of malaria symptoms and methods of prevention. The mean knowledge of malaria symptoms is higher in the intervention schools 4.4 ± 1.9, compared with 2.1 ± 1.4 in the non-intervention group. With statistically significant difference (P < 0.001), also the positive attitude and practice toward malaria was higher to be (48%) in the intervention group;compared with (35%) in the non-intervention group the difference was statistically significant. The knowledge of mode of malaria transmission was higher in the intervention schools to be (86.2%) compared with (59.1%) in the non-intervention group, with statistically significant deference (P value <0.001). The knowledge of fever as a main malaria symptom was higher to be (90.4%) in the intervention schools compared with (63.6%) in the non-intervention schools with statistically significant deference. Conclusions and Recommendation: This study concludes that the health education intervention in primary schools in Taize governorate had a positive impact on the knowledge, attitude and practice of pupils. We recommend to conduct similar methods of the health education activities in schools with suitable modifications to reach all schools level.展开更多
Objectives: To investigate lipid and diabetic profiles of school teachers in Kabul, Afghanistan, who face food insecurity, and examine the association of those with the teachers’ knowledge of non-communicable disease...Objectives: To investigate lipid and diabetic profiles of school teachers in Kabul, Afghanistan, who face food insecurity, and examine the association of those with the teachers’ knowledge of non-communicable diseases (NCDs). Methods: A survey to examine biochemical indicators of NCDs (triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), hemoglobin A1c (HbA1c), blood pressure, height, weight, waist circumference), food insecurity, lifestyle and knowledge of NCDs was conducted among 600 school teachers. Analyses were made of biochemical indicators of NCDs, blood pressure, metabolic syndrome, obesity, and subject’s lifestyle in relation to food security and the subject’s knowledge of NCDs. Results: Thirty-nine percent of school teachers experienced food insecurity. The percentage of TC ≥ 200 mg/dL;HbA1c ≥ 5.5%;hypertension and metabolic syndrome were 20.2%, 29.7%, 32.2% and 33.7%, respectively. Food insecurity was associated with lower fruit and vegetable consumption and higher potato consumption. Food insecurity was associated with increased TC (AOR 2.03;95%CI: 1.23 - 3.34), decreased HDL (AOR 1.70;95%CI: 1.12 - 2.58), increased HbA1c (AOR 1.73;95%CI: 1.14 - 2.64), hypertension (AOR 1.68;95%CI: 1.01 - 2.80) and diagnosis of metabolic syndrome (AOR 1.78;95%CI: 1.18 - 2.68), after adjustment by demographic, socioeconomic and lifestyle variables. Among people living under condition of food insecurity, greater NCD knowledge was associated with smaller prevalence of TG ≥ 150 mg/dL, HDL Conclusions: Under conditions of food insecurity, diets have less variety and individuals are more likely to exhibit biomedical risk factors of NCDs. Even under conditions of food insecurity, people with knowledge of NCDs may have better coping strategies for their choice of lifestyles and exhibited a lower percentage of risk factors of NCDs.展开更多
Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised q...Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.展开更多
Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data f...Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.展开更多
Malaria is considered as one of the main health problem in the Republic of Yemen. In February 2006 National Malaria Control Program started freely distribution of Long Lasting Impregnated Nets (LLINs) for vulnerable g...Malaria is considered as one of the main health problem in the Republic of Yemen. In February 2006 National Malaria Control Program started freely distribution of Long Lasting Impregnated Nets (LLINs) for vulnerable groups to malaria infection (pregnant women and children under 5 years). After one year of distribution, there is a need to measure the use rate among vulnerable groups and explore factors affecting their use. The aim of the study was to investigate the use rate of long lasting impregnated nets among children under five years and pregnant women in Al Moneera city and Al Koozi villages of Hodieda governorate. Methodology: Cross section study with multistage sample, Random selection of one urban and one rural locality. 768 housewives were interviewed, proportionally allocated sample according to the number of vulnerable groups in each locality. Systematic random sample to select households. Results: The use rate of LLINs for vulnerable groups was 74.3% CI (71.2 - 77.4). There was no statistically significant association between the use of LLINs and residence, also with ages of housewives, occupation, type of house, but there is strong statistically significant association between use of LLINs and having correct information about how to use and to take care of them P value < 0.001, also with educational status of housewives;P value 0.03 and educational status of fathers;P value 0.01. (84%) have correct information about how to use and take care of LLINs and the main source of information was health workers who distributed them. Only 13.4% realized pregnant women as a vulnerable group to malaria infection while about 77.9% realized children as a vulnerable group to malaria infection. The main reason of LLINs use (84.8%) was protection from nuisance of insects. Conclusion and recommendations: There is shortage in the information about the protective effect of LLINs from malaria infection and the main reason of using them is protection from nuisance of insects. There is a need to increase health awareness about the role of LLINs in malaria prevention.展开更多
Background: Poor regulation is a barrier to adolescents’ accessing family planning (FP) services. We aimed to assess policies, laws, and regulations according to the contraceptive needs of adolescents in the Democrat...Background: Poor regulation is a barrier to adolescents’ accessing family planning (FP) services. We aimed to assess policies, laws, and regulations according to the contraceptive needs of adolescents in the Democratic Republic of the Congo (DRC). Methods: A mixed method study was conducted in 74 structures, including 13 administrative structures and 61 facilities offering FP. Data were collected through semi-structured interviews and document review. Using a health policy analysis framework, we analyzed the types of policies;their availability at the delivery points;the actors and the context of the policy formulation process. The content of policies was analyzed on the basis of WHO recommendations to ensure respect for human rights in the provision of contraceptive information and services. Results: Of the policies targeting the sexual and reproductive health (SRH), 18 were mainly focused on the FP of which 5 were the standards and directives;5 implementing documents;3 guidelines;3 laws and 2 policies. Twelve documents were classified “important” for the FP extension. However, a few targeted adolescents and were translated into operational instructions for providers. Of 9 WHO recommendations, one was fully and two partially integrated into FP policies. Adolescents and FP providers were less involved in the policy formulation process. Conclusion: The FP regulation remains problematic in the DRC. FP policies are unsuitable to adolescents’ expectation;they do not guarantee a secure and unrestricted access to FP services. The ministry of health should put in place evidence-based regulations to improve access to SRH services by adolescents.展开更多
Background: Malaria has historically been a major public health concern in Yemen, noted to be the country with the highest prevalence in the Eastern Mediterranean Region. As more and more children attend school, gover...Background: Malaria has historically been a major public health concern in Yemen, noted to be the country with the highest prevalence in the Eastern Mediterranean Region. As more and more children attend school, governments are increasingly recognizing the importance of child health for educational achievement. Aim: The aim is to assess the baseline knowledge, attitude and practice of pupil towards malaria before the health education activities. Methods: We conducted a cross-sectional study, in four randomly selected districts (rural and urban) of Taiz governorate. The study population was 1598 pupils in primary schools. Data was collected using questioner. Results: The pupils who recognized mosquito bite as a route of malaria transmission was 769 (48.1%), while the pupils who recognized fever as the main symptom were 786 (49.2%), 281 (17.58%) of pupils recognized convulsion as a complication of malaria. Regarding protective method 881 (55.31%) were mentioned the cover of the tanks as a protective method, about the BN 293 (18.3%) of pupils known about the BN and 280 (17.5%) mentioned children & pregnancy were the vulnerable groups to malaria. Conclusions and Recommendation: the percentage of knowledge of malaria knowledge and methods of prevention was low (24.5%). Also, the positive attitude and practice toward malaria was 45%. The rate of having bed-nets was very low (10.1%). There were misconceptions of malaria cause and transmission (48.1%). We recommend conducting health education activities that will focus on increasing the knowledge, attitude and practice levels of malaria among school pupils.展开更多
Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done ...Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years;prior treatment failure;defaulters;the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they should reduce sample delivery times when they use culture and DST concomitantly.展开更多
<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS sp...<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. <strong>Methods: </strong>A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. <strong>Results: </strong>HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. <strong>Conclusion: </strong>Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.展开更多
Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hosp...Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hospitals for Sana’a city. Method: This applied research is a descriptive, cross-sectional study in which the HIS of 7 hospitals affiliated with Sana’a city hospitals during “2017-2020”, was evaluated based on Self-administered questionnaires. Data were collected by using Self-administered questionnaires and analyzed in SPSS 16 by using descriptive statistics. Results: A total of 626 users (95.7%) had responded. 73%, 75%, 69%, 70%, 71% of users mentioned that resources were available, for physical, software, human, organizational, and decision computerized HIS, respectively. The study showed a strong relationship between computerized information systems with their physical, software, human and organizational components, and medical and administrative decisions. While the study showed the absence of a relationship between demographic factors and computerized information systems with their hardware, software, human and organizational components, medical and administrative decisions, except for gender with organizational components, age, qualification with hardware and software components, and years of experience with all study variables. Conclusion: The application of HIS at hospitals in decision-making has several challenges, including the lack of updating of hardware and software components Furthermore, the absence of specific, focusing on developing their technical staffs, and mobilizing financial resources to achieve implementation properly. Therefore, establishing the technical management with clear roles and tasks with multi-disciplinary, and increasing the support of the administrative leadership in the process of implementing HIS are recommended.展开更多
Background: Total quality management (TQM) plays a major role in quality health services improvement. The aims of the study are to identify the concepts of total quality management in health institutions to know the n...Background: Total quality management (TQM) plays a major role in quality health services improvement. The aims of the study are to identify the concepts of total quality management in health institutions to know the nature of the relationship between the application of TQM and improving the quality of health services in Sana’a Governorate. Method: This applied research is a descriptive cross-sectional study in which the TQM of 13 affiliated Sana’a Governorate hospitals during “2017-2020”, were evaluated based on self-administered questionnaires. Data were collected by questionnaires including demographical variables, TQM dimensions variables. Data were analyzed by using SPSS version 16. Results: A total of 281 users 98.6% had responded. The employee’s responses for sixth study dimensions were the top manager’s commitment (TMC) 80.46%, customers focusing CF 81.55%, continuous improvement (CI) 82.32%, training (T) 71.51%, and strategic planning of the quality (SPQ) 74.76%, health services quality improvement (HSQI) 74.25%. There is a strong relationship between TQM and HSQI. There is no relationship between demographic factors gender, profession, years of experience, except age with TMC, T, HSQI, qualification with the TMC, CI, T, HSQI and job with all study variables. Conclusion: The application of TQM at hospitals in quality of health services improvement has several challenges, lacking staff experience and lacking leadership support, weakness of the training, customers focusing, continuous improvement, and strategic planning of the quality. Therefore, benefiting from the experiences of leading hospitals in implementing total quality management programs by sending some cadres to these hospitals for training and gaining experience or by hosting experienced cadres to conduct training courses is recommended.展开更多
The objective of this study is to conduct a literature review to assess the importance of pharmacoeconomics in developing pharmacovigilance activities as a working tool to guide the process of decision making in the h...The objective of this study is to conduct a literature review to assess the importance of pharmacoeconomics in developing pharmacovigilance activities as a working tool to guide the process of decision making in the health field. The authors have done a literature review in order to find information about pharmacovigilance and their relationship with the pharmacoeconomics field, as an important element to assess the economic and health consequences because of the use of drugs in health systems. From this study, it can be found that pharmaeoeconomics applied to the pharmacovigilance activities should be considered as an aspect that contributes to improving the rational use of medicines, because it allows to compare the costs and consequences （beneficial and detrimental） with the use of different pharmacotberapeutic alternatives, in order to assess the negative effects due to ADRs （adverse drug reactions）, which directly increase the morbidity and mortality in patients, increase the direct health costs and indirectly decrease the productivity labors. It can be also concluded that pharmacoeconomics constitutes an important aspect to the pharmacovigilance activity in the health systems, in order to evaluate the negative impact of ADR, both on patient health as its economic implications, due to associated costs with these adverse effects.展开更多
Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article ...Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article reviews the campaign’s planning process, the results, challenges, and lessons learned. Methods: A descriptive method was used to postpone the planning and implementation process according to the National Malaria Control Program (NMCP) standards adapted to the COVID-19 context. The changes and adaptations implemented as well as the challenges encountered are described. Results: Between January 2018 to June 2021, 23 LLIN mass distribution campaigns were organized in the DRC with the financial support of The Global Fund to Fight against Tuberculosis, AIDS and Malaria (GFTAM) and Against Malaria Foundation (AMF) allowing the distribution of 55,273,473 LLINs to 19,048,372 households at risk of malaria transmission with an average of 2.9 LLINs per household. The enumerated population (111,081,191) exceeded 7% of the micro plans projected population (102,790,391) while the number of households enumerated (19,311,629) was 3% lower compared to the micro planning projection households (19,862,417). Compared to a reported household coverage of 96% of households achieved over the expected households, the independent monitoring carried out revealed 91% of households served in the intervention areas. The main reasons for not reaching households mentioned by the respondents were absence at the time of distribution (26%) followed by the loss of vouchers (16%). Several communication channels were used among which, community workers were the most frequently mentioned (63.1%), followed by radios (18.5%) and churches (12.4%). Conclusion: Good planning, effective coordination of stakeholders, and revision of the implementing campaigns methods following the COVID-19 were factors in the success of this campaign. An effort to respect the schedules for renewing LLINs in households, coupled with good continuous distribution, is necessary to maintain the gains and hope for an impact in terms of morbidity and mortality reduction of malaria.展开更多
Background and Objectives: Mitigation of antibiotic resistant Neisseria gonorrhoeae has become a priority due to considerable health and economical disabilities it generates. In order to tackle the emergence of resist...Background and Objectives: Mitigation of antibiotic resistant Neisseria gonorrhoeae has become a priority due to considerable health and economical disabilities it generates. In order to tackle the emergence of resistant Neisseria gonorrhoeae, this study aimed to determine the prevalence and risk factors of penicillinase type β-lactamase-producing Neisseria gonorrheae among patients consulting for genital infectious disorders in two health-facilities in Yaounde, Cameroon. Materials and Method: A cross-sectional descriptive and analytical study was conducted over a 3-month period, from July 2<sup>nd</sup> to October 2<sup>nd</sup>, 2022. Vaginal and urethral secretions were collected. Biochemical identification tests were performed on colonies grown on chocolate agar + polyvitex using the Api NH gallery. The detection of penicillinases was equally performed using the API NH gallery and confirmed using the antimicrobial susceptibility testing. The Minimum Inhibitory Concentrations of some antibiotics were determined using the E-Test. Results: The results showed that out of the 198 patients sampled, 16 (8.08%) were positive for Neisseria gonorrhoeae, among which 13/16 (81.25%) were penicillinase-type β-lactamase producers. Antimicrobial susceptibility testing results showed high co-resistances to antibiotics, mainly ciprofloxacin (100%), nalidixic acid (92.31%) and azithromycin (84.62%). Moreover, high Minimum Inhibitory Concentrations of ceftriaxone (ranging from 6 to 24 mg/L) was observed toward Neisseria gonorrhoeae isolates. The risk factors of the carriage of penicillinase-type β-lactamase producing Neisseria gonorrhoeae identified were: a history of Sexually Transmitted infections (p = 0.01) and unprotected sexual intercourse (p = 0.01). Conclusion: The emergence of penicillinase-type β-lactamase producing Neisseria gonorrhoeae is increasing and the situation is becoming worrisome. The identified risk factors can constitute a basic outlook to tackle resistant Neisseria gonorrhoeae, and therefore sustain antibiotic stewardship.展开更多
Background: In accordance with its measles elimination strategic plan 2012-2020, the Democratic Republic of the Congo (DRC) organized a follow-up vaccination campaign against measles from October to December 2019 in 2...Background: In accordance with its measles elimination strategic plan 2012-2020, the Democratic Republic of the Congo (DRC) organized a follow-up vaccination campaign against measles from October to December 2019 in 26 provinces. This study aims to establish the contribution of this supplementary vaccination campaign to protecting children against measles. Methods: The survey was carried out in November 2020 among households of the DRC, according to the 2018 revised version of the World Health Organization’s stratified cluster sampling method, using multiple stage sampling. It targeted 280 children aged 6 - 59 months per stratum or province, with 10 children in each of the 28 selected clusters. Data collection using tablets with centralized and real-time data processing was preceded by enumeration to refine the household sampling frame. Clusters and households were selected by random draw. Data collected with CS Pro 7 software were analyzed with SPSS, Epi info 7 and Excel software to determine indicators and make before-after comparisons using the McNemar test, at a precision threshold of 5%. Results: Of the 8535 surveyed children, 89.5% were vaccinatedduring the follow-up campaign and 81.6% were vaccinated before. Only 3.7% had correctly completed campaign vaccination cards. Estimated vaccination coverage increased from 80.8% before the campaign to 92.6% after the campaign (p 0.001). Vaccination coverage after campaign against measles improved in all provinces (p < 0.001) except Bas-Uele and Maniema. Thirteen provinces reached the national coverage target of 95%, compared to five before the campaign. The proportion of zero-dose children dropped significantly after this campaign from 19.2% to 7.4% (p 0.001), and even fell below 1% in six provinces. Conclusion: This measles vaccination campaign improved overall vaccination coverage by 10% and reached more unvaccinated children. Efforts must continue to improve the retention of vaccination card, the adherence of unvaccinated children and the effectiveness of routine vaccination.展开更多
Amyloid-beta clearance plays a key role in the pathogenesis of Alzheimer's disease.H oweve r,the variation in functional proteins involved in amyloid-beta clearance and their correlation with amyloid-beta levels r...Amyloid-beta clearance plays a key role in the pathogenesis of Alzheimer's disease.H oweve r,the variation in functional proteins involved in amyloid-beta clearance and their correlation with amyloid-beta levels remain unclea r.In this study,we conducted meta-analyses and a systematic review using studies from the PubMed,Embase,Web of Science,and Cochrane Library databases,including journal articles published from inception to J une 30,2023.The inclusion criteria included studies comparing the levels of functional proteins associated with amyloid-beta clearance in the blood,cere b rospinal fluid,and brain of healthy controls,patients with mild cognitive impairment,and patients with Alzheimer's disease.Additionally,we analyzed the correlation between these functional proteins and amyloid-beta levels in patients with Alzheimer's disease.The methodological quality of the studies was assessed via the Newcastle-Ottawa Scale.Owing to heterogeneity,we utilized either a fixed-effect or random-effect model to assess the 95%confidence interval(CI)of the standard mean difference(SMD)among healthy controls,patients with mild cognitive impairment,and patients with Alzheimer's disease.The findings revealed significant alterations in the levels of insulin-degrading enzymes,neprilysin,matrix metalloproteinase-9,cathepsin D,receptor for advanced glycation end products,and P-glycoprotein in the brains of patients with Alzheimer's disease,patients with mild cognitive impairment,and healthy controls.In cerebrospinal fluid,the levels of triggering receptor expressed on myeloid cells 2 and ubiquitin C-terminal hydrolase L1 are altered,whereas the levels of TREM2,CD40,CD40L,CD14,CD22,cathepsin D,cystatin C,andα2 M in peripheral blood differ.Notably,TREM2 and cathepsin D showed changes in both brain(SMD=0.31,95%CI:0.16-0.47,P<0.001,I^(2)=78.4%;SMD=1.24,95%CI:0.01-2.48,P=0.048,I^(2)=90.1%)and peripheral blood(SMD=1.01,95%CI:0.35-1.66,P=0.003,I^(2)=96.5%;SMD=7.55,95%CI:3.92-11.18,P<0.001,I^(2)=98.2%)samples.Furthermore,correlations were observed between amyloid-beta levels and the levels of TREM2(r=0.16,95%CI:0.04-0.28,P=0.009,I^(2)=74.7%),neprilysin(r=-0.47,95%CI:-0.80-0.14,P=0.005,I^(2)=76.1%),and P-glycoprotein(r=-0.31,95%CI:-0.51-0.11,P=0.002,I^(2)=0.0%)in patients with Alzheimer's disease.These findings suggest that triggering receptor expressed on myeloid cells 2 and cathepsin D could serve as potential diagnostic biomarkers for Alzheimer's disease,whereas triggering receptor expressed on myeloid cells 2,neprilysin,and P-glycoprotein may represent potential therapeutic targets.展开更多
The Fe_(1−x)Ni_(x)VO_(4)(x=0,0.05,0.10,and 0.20)nanoparticles in this work were successfully synthesized via a co-precipitation method.The structural,magnetic and electrochemical properties of the prepared Fe_(1−x)Ni_...The Fe_(1−x)Ni_(x)VO_(4)(x=0,0.05,0.10,and 0.20)nanoparticles in this work were successfully synthesized via a co-precipitation method.The structural,magnetic and electrochemical properties of the prepared Fe_(1−x)Ni_(x)VO_(4) nanoparticles were studied as a function of Ni content.The experimental results show that the prepared Ni-doped FeVO_(4) samples have a triclinic structure.Scanning electron microscopy(SEM)images reveal a decrease in average nanoparticle size with increasing Ni content,leading to an enhancement in both specific surface area and magnetization values.X-ray absorption near edge structure(XANES)analysis confirms the substitution of Ni^(2+)ions into Fe^(3+)sites.The magnetic investigation reveals that Ni-doped FeVO_(4) exhibits weak ferromagnetic behavior at room temperature,in contrast to the antiferromagnetic behavior observed in the undoped FeVO_(4).Electrochemical studies demonstrate that the Fe_(0.95)Ni_(0.05)VO_(4) electrode achieves the highest specific capacitance of 334.05 F·g^(−1) at a current density of 1 A·g^(−1),which is attributed to its smallest average pore diameter.In addition,the enhanced specific surface of the Fe_(0.8)Ni_(0.2)VO_(4) electrode is responsible for its outstanding cyclic stability.Overall,our results suggest that the magnetic and electrochemical properties of FeVO_(4) nanoparticles could be effectively tuned by varying Ni doping contents.展开更多
The fossil shells on the sedimentary rocks were collected from The Historical Park,Ban Sap Noi Geopark,Phetchabun Province,Thailand.However,the fossils remained in this area were investigated on the characteristic spe...The fossil shells on the sedimentary rocks were collected from The Historical Park,Ban Sap Noi Geopark,Phetchabun Province,Thailand.However,the fossils remained in this area were investigated on the characteristic species only in geological studies with taxonomy for fossil age predicting.To fill up the gap of these studies,the material characterization techniques were used to study the chemical composition and structure of fossil shells I,II and III.The results clearly showed that the morphologies of all fossil shells were Brachiopod fossils with different species.The functional group and elemental composition of all fossil shells showed that the high content of calcium carbonate was a major composition.In addition,the high content of quartz indicated the silica precipitation phenomenon in all fossil shells.The element composition of cross-sectional morphology and energy dispersive spectroscope (EDS mapping) were used to confirm the presence of Si element in each zone of fossil shells.The crystal structures of all fossil shells were investigated and indicated that the calcium carbonate compound was a calcite phase and silicon dioxide compound was a quartz phase.Moreover,the crystal structure of quartz phase was used to calculate the crystallinity index.The crystallinity index values in all fossil shells indicated a well-crystallized quartz.The age of fossil shells was estimated and found to be brachiopod fossil in carboniferous period with the age of about 359.2 to 299.0 million years.展开更多
BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with ...BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.展开更多
文摘BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.
文摘<p align="justify"> <span style="font-family:Verdana;">Background: Malaria is one of the main health problems in Yemen. Health education is essential for the control of diseases such as malaria. School-age children represent 25% of Yemen’s population. Schools children can convey the knowledge and skills that they acquire at school to the community, thus increasing general community awareness about malaria. Aim to determine the impact of school-based malaria education intervention on knowledge, attitude and practice of school children towards malaria prevention and control. Methods: We conducted a community-based trial, intervention and non-intervention comparison (exposed & non-exposed), in four randomly selected districts (rural and urban) of Taiz governorate. This study was conducted in four districts of Taiz governorate. The study population was 2130 pupils of grade 6, 7, and 8 in primary schools, chosen from four randomly selected districts;two of them were rural and the others urban. Four schools and their pupils (1065 pupils) were chosen for the study and assigned as an intervention group and four schools with their pupils (1065) were chosen for the study and assigned as a non-intervention (1065 pupils). Data were collected using questioner in intervention and non-intervention schools (three months apart). The major intervention activities included lectures about malaria, distribution of educational materials. χ<sup>2</sup> was used to analyze differences. Results: Health education activities in schools were associated with the increased knowledge of malaria symptoms and methods of prevention. The mean knowledge of malaria symptoms is higher in the intervention schools 4.4 ± 1.9, compared with 2.1 ± 1.4 in the non-intervention group. With statistically significant difference (P < 0.001), also the positive attitude and practice toward malaria was higher to be (48%) in the intervention group;compared with (35%) in the non-intervention group the difference was statistically significant. The knowledge of mode of malaria transmission was higher in the intervention schools to be (86.2%) compared with (59.1%) in the non-intervention group, with statistically significant deference (P value <0.001). The knowledge of fever as a main malaria symptom was higher to be (90.4%) in the intervention schools compared with (63.6%) in the non-intervention schools with statistically significant deference. Conclusions and Recommendation: This study concludes that the health education intervention in primary schools in Taize governorate had a positive impact on the knowledge, attitude and practice of pupils. We recommend to conduct similar methods of the health education activities in schools with suitable modifications to reach all schools level.
文摘Objectives: To investigate lipid and diabetic profiles of school teachers in Kabul, Afghanistan, who face food insecurity, and examine the association of those with the teachers’ knowledge of non-communicable diseases (NCDs). Methods: A survey to examine biochemical indicators of NCDs (triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), hemoglobin A1c (HbA1c), blood pressure, height, weight, waist circumference), food insecurity, lifestyle and knowledge of NCDs was conducted among 600 school teachers. Analyses were made of biochemical indicators of NCDs, blood pressure, metabolic syndrome, obesity, and subject’s lifestyle in relation to food security and the subject’s knowledge of NCDs. Results: Thirty-nine percent of school teachers experienced food insecurity. The percentage of TC ≥ 200 mg/dL;HbA1c ≥ 5.5%;hypertension and metabolic syndrome were 20.2%, 29.7%, 32.2% and 33.7%, respectively. Food insecurity was associated with lower fruit and vegetable consumption and higher potato consumption. Food insecurity was associated with increased TC (AOR 2.03;95%CI: 1.23 - 3.34), decreased HDL (AOR 1.70;95%CI: 1.12 - 2.58), increased HbA1c (AOR 1.73;95%CI: 1.14 - 2.64), hypertension (AOR 1.68;95%CI: 1.01 - 2.80) and diagnosis of metabolic syndrome (AOR 1.78;95%CI: 1.18 - 2.68), after adjustment by demographic, socioeconomic and lifestyle variables. Among people living under condition of food insecurity, greater NCD knowledge was associated with smaller prevalence of TG ≥ 150 mg/dL, HDL Conclusions: Under conditions of food insecurity, diets have less variety and individuals are more likely to exhibit biomedical risk factors of NCDs. Even under conditions of food insecurity, people with knowledge of NCDs may have better coping strategies for their choice of lifestyles and exhibited a lower percentage of risk factors of NCDs.
基金supported by Faculty of Medicine Siriraj Hospital,Mahidol University,Thailand(Grant No.[IO]R016233023).
文摘Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.
文摘Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.
文摘Malaria is considered as one of the main health problem in the Republic of Yemen. In February 2006 National Malaria Control Program started freely distribution of Long Lasting Impregnated Nets (LLINs) for vulnerable groups to malaria infection (pregnant women and children under 5 years). After one year of distribution, there is a need to measure the use rate among vulnerable groups and explore factors affecting their use. The aim of the study was to investigate the use rate of long lasting impregnated nets among children under five years and pregnant women in Al Moneera city and Al Koozi villages of Hodieda governorate. Methodology: Cross section study with multistage sample, Random selection of one urban and one rural locality. 768 housewives were interviewed, proportionally allocated sample according to the number of vulnerable groups in each locality. Systematic random sample to select households. Results: The use rate of LLINs for vulnerable groups was 74.3% CI (71.2 - 77.4). There was no statistically significant association between the use of LLINs and residence, also with ages of housewives, occupation, type of house, but there is strong statistically significant association between use of LLINs and having correct information about how to use and to take care of them P value < 0.001, also with educational status of housewives;P value 0.03 and educational status of fathers;P value 0.01. (84%) have correct information about how to use and take care of LLINs and the main source of information was health workers who distributed them. Only 13.4% realized pregnant women as a vulnerable group to malaria infection while about 77.9% realized children as a vulnerable group to malaria infection. The main reason of LLINs use (84.8%) was protection from nuisance of insects. Conclusion and recommendations: There is shortage in the information about the protective effect of LLINs from malaria infection and the main reason of using them is protection from nuisance of insects. There is a need to increase health awareness about the role of LLINs in malaria prevention.
文摘Background: Poor regulation is a barrier to adolescents’ accessing family planning (FP) services. We aimed to assess policies, laws, and regulations according to the contraceptive needs of adolescents in the Democratic Republic of the Congo (DRC). Methods: A mixed method study was conducted in 74 structures, including 13 administrative structures and 61 facilities offering FP. Data were collected through semi-structured interviews and document review. Using a health policy analysis framework, we analyzed the types of policies;their availability at the delivery points;the actors and the context of the policy formulation process. The content of policies was analyzed on the basis of WHO recommendations to ensure respect for human rights in the provision of contraceptive information and services. Results: Of the policies targeting the sexual and reproductive health (SRH), 18 were mainly focused on the FP of which 5 were the standards and directives;5 implementing documents;3 guidelines;3 laws and 2 policies. Twelve documents were classified “important” for the FP extension. However, a few targeted adolescents and were translated into operational instructions for providers. Of 9 WHO recommendations, one was fully and two partially integrated into FP policies. Adolescents and FP providers were less involved in the policy formulation process. Conclusion: The FP regulation remains problematic in the DRC. FP policies are unsuitable to adolescents’ expectation;they do not guarantee a secure and unrestricted access to FP services. The ministry of health should put in place evidence-based regulations to improve access to SRH services by adolescents.
文摘Background: Malaria has historically been a major public health concern in Yemen, noted to be the country with the highest prevalence in the Eastern Mediterranean Region. As more and more children attend school, governments are increasingly recognizing the importance of child health for educational achievement. Aim: The aim is to assess the baseline knowledge, attitude and practice of pupil towards malaria before the health education activities. Methods: We conducted a cross-sectional study, in four randomly selected districts (rural and urban) of Taiz governorate. The study population was 1598 pupils in primary schools. Data was collected using questioner. Results: The pupils who recognized mosquito bite as a route of malaria transmission was 769 (48.1%), while the pupils who recognized fever as the main symptom were 786 (49.2%), 281 (17.58%) of pupils recognized convulsion as a complication of malaria. Regarding protective method 881 (55.31%) were mentioned the cover of the tanks as a protective method, about the BN 293 (18.3%) of pupils known about the BN and 280 (17.5%) mentioned children & pregnancy were the vulnerable groups to malaria. Conclusions and Recommendation: the percentage of knowledge of malaria knowledge and methods of prevention was low (24.5%). Also, the positive attitude and practice toward malaria was 45%. The rate of having bed-nets was very low (10.1%). There were misconceptions of malaria cause and transmission (48.1%). We recommend conducting health education activities that will focus on increasing the knowledge, attitude and practice levels of malaria among school pupils.
文摘Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years;prior treatment failure;defaulters;the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they should reduce sample delivery times when they use culture and DST concomitantly.
文摘<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. <strong>Methods: </strong>A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. <strong>Results: </strong>HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. <strong>Conclusion: </strong>Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.
文摘Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hospitals for Sana’a city. Method: This applied research is a descriptive, cross-sectional study in which the HIS of 7 hospitals affiliated with Sana’a city hospitals during “2017-2020”, was evaluated based on Self-administered questionnaires. Data were collected by using Self-administered questionnaires and analyzed in SPSS 16 by using descriptive statistics. Results: A total of 626 users (95.7%) had responded. 73%, 75%, 69%, 70%, 71% of users mentioned that resources were available, for physical, software, human, organizational, and decision computerized HIS, respectively. The study showed a strong relationship between computerized information systems with their physical, software, human and organizational components, and medical and administrative decisions. While the study showed the absence of a relationship between demographic factors and computerized information systems with their hardware, software, human and organizational components, medical and administrative decisions, except for gender with organizational components, age, qualification with hardware and software components, and years of experience with all study variables. Conclusion: The application of HIS at hospitals in decision-making has several challenges, including the lack of updating of hardware and software components Furthermore, the absence of specific, focusing on developing their technical staffs, and mobilizing financial resources to achieve implementation properly. Therefore, establishing the technical management with clear roles and tasks with multi-disciplinary, and increasing the support of the administrative leadership in the process of implementing HIS are recommended.
文摘Background: Total quality management (TQM) plays a major role in quality health services improvement. The aims of the study are to identify the concepts of total quality management in health institutions to know the nature of the relationship between the application of TQM and improving the quality of health services in Sana’a Governorate. Method: This applied research is a descriptive cross-sectional study in which the TQM of 13 affiliated Sana’a Governorate hospitals during “2017-2020”, were evaluated based on self-administered questionnaires. Data were collected by questionnaires including demographical variables, TQM dimensions variables. Data were analyzed by using SPSS version 16. Results: A total of 281 users 98.6% had responded. The employee’s responses for sixth study dimensions were the top manager’s commitment (TMC) 80.46%, customers focusing CF 81.55%, continuous improvement (CI) 82.32%, training (T) 71.51%, and strategic planning of the quality (SPQ) 74.76%, health services quality improvement (HSQI) 74.25%. There is a strong relationship between TQM and HSQI. There is no relationship between demographic factors gender, profession, years of experience, except age with TMC, T, HSQI, qualification with the TMC, CI, T, HSQI and job with all study variables. Conclusion: The application of TQM at hospitals in quality of health services improvement has several challenges, lacking staff experience and lacking leadership support, weakness of the training, customers focusing, continuous improvement, and strategic planning of the quality. Therefore, benefiting from the experiences of leading hospitals in implementing total quality management programs by sending some cadres to these hospitals for training and gaining experience or by hosting experienced cadres to conduct training courses is recommended.
文摘The objective of this study is to conduct a literature review to assess the importance of pharmacoeconomics in developing pharmacovigilance activities as a working tool to guide the process of decision making in the health field. The authors have done a literature review in order to find information about pharmacovigilance and their relationship with the pharmacoeconomics field, as an important element to assess the economic and health consequences because of the use of drugs in health systems. From this study, it can be found that pharmaeoeconomics applied to the pharmacovigilance activities should be considered as an aspect that contributes to improving the rational use of medicines, because it allows to compare the costs and consequences （beneficial and detrimental） with the use of different pharmacotberapeutic alternatives, in order to assess the negative effects due to ADRs （adverse drug reactions）, which directly increase the morbidity and mortality in patients, increase the direct health costs and indirectly decrease the productivity labors. It can be also concluded that pharmacoeconomics constitutes an important aspect to the pharmacovigilance activity in the health systems, in order to evaluate the negative impact of ADR, both on patient health as its economic implications, due to associated costs with these adverse effects.
文摘Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article reviews the campaign’s planning process, the results, challenges, and lessons learned. Methods: A descriptive method was used to postpone the planning and implementation process according to the National Malaria Control Program (NMCP) standards adapted to the COVID-19 context. The changes and adaptations implemented as well as the challenges encountered are described. Results: Between January 2018 to June 2021, 23 LLIN mass distribution campaigns were organized in the DRC with the financial support of The Global Fund to Fight against Tuberculosis, AIDS and Malaria (GFTAM) and Against Malaria Foundation (AMF) allowing the distribution of 55,273,473 LLINs to 19,048,372 households at risk of malaria transmission with an average of 2.9 LLINs per household. The enumerated population (111,081,191) exceeded 7% of the micro plans projected population (102,790,391) while the number of households enumerated (19,311,629) was 3% lower compared to the micro planning projection households (19,862,417). Compared to a reported household coverage of 96% of households achieved over the expected households, the independent monitoring carried out revealed 91% of households served in the intervention areas. The main reasons for not reaching households mentioned by the respondents were absence at the time of distribution (26%) followed by the loss of vouchers (16%). Several communication channels were used among which, community workers were the most frequently mentioned (63.1%), followed by radios (18.5%) and churches (12.4%). Conclusion: Good planning, effective coordination of stakeholders, and revision of the implementing campaigns methods following the COVID-19 were factors in the success of this campaign. An effort to respect the schedules for renewing LLINs in households, coupled with good continuous distribution, is necessary to maintain the gains and hope for an impact in terms of morbidity and mortality reduction of malaria.
文摘Background and Objectives: Mitigation of antibiotic resistant Neisseria gonorrhoeae has become a priority due to considerable health and economical disabilities it generates. In order to tackle the emergence of resistant Neisseria gonorrhoeae, this study aimed to determine the prevalence and risk factors of penicillinase type β-lactamase-producing Neisseria gonorrheae among patients consulting for genital infectious disorders in two health-facilities in Yaounde, Cameroon. Materials and Method: A cross-sectional descriptive and analytical study was conducted over a 3-month period, from July 2<sup>nd</sup> to October 2<sup>nd</sup>, 2022. Vaginal and urethral secretions were collected. Biochemical identification tests were performed on colonies grown on chocolate agar + polyvitex using the Api NH gallery. The detection of penicillinases was equally performed using the API NH gallery and confirmed using the antimicrobial susceptibility testing. The Minimum Inhibitory Concentrations of some antibiotics were determined using the E-Test. Results: The results showed that out of the 198 patients sampled, 16 (8.08%) were positive for Neisseria gonorrhoeae, among which 13/16 (81.25%) were penicillinase-type β-lactamase producers. Antimicrobial susceptibility testing results showed high co-resistances to antibiotics, mainly ciprofloxacin (100%), nalidixic acid (92.31%) and azithromycin (84.62%). Moreover, high Minimum Inhibitory Concentrations of ceftriaxone (ranging from 6 to 24 mg/L) was observed toward Neisseria gonorrhoeae isolates. The risk factors of the carriage of penicillinase-type β-lactamase producing Neisseria gonorrhoeae identified were: a history of Sexually Transmitted infections (p = 0.01) and unprotected sexual intercourse (p = 0.01). Conclusion: The emergence of penicillinase-type β-lactamase producing Neisseria gonorrhoeae is increasing and the situation is becoming worrisome. The identified risk factors can constitute a basic outlook to tackle resistant Neisseria gonorrhoeae, and therefore sustain antibiotic stewardship.
文摘Background: In accordance with its measles elimination strategic plan 2012-2020, the Democratic Republic of the Congo (DRC) organized a follow-up vaccination campaign against measles from October to December 2019 in 26 provinces. This study aims to establish the contribution of this supplementary vaccination campaign to protecting children against measles. Methods: The survey was carried out in November 2020 among households of the DRC, according to the 2018 revised version of the World Health Organization’s stratified cluster sampling method, using multiple stage sampling. It targeted 280 children aged 6 - 59 months per stratum or province, with 10 children in each of the 28 selected clusters. Data collection using tablets with centralized and real-time data processing was preceded by enumeration to refine the household sampling frame. Clusters and households were selected by random draw. Data collected with CS Pro 7 software were analyzed with SPSS, Epi info 7 and Excel software to determine indicators and make before-after comparisons using the McNemar test, at a precision threshold of 5%. Results: Of the 8535 surveyed children, 89.5% were vaccinatedduring the follow-up campaign and 81.6% were vaccinated before. Only 3.7% had correctly completed campaign vaccination cards. Estimated vaccination coverage increased from 80.8% before the campaign to 92.6% after the campaign (p 0.001). Vaccination coverage after campaign against measles improved in all provinces (p < 0.001) except Bas-Uele and Maniema. Thirteen provinces reached the national coverage target of 95%, compared to five before the campaign. The proportion of zero-dose children dropped significantly after this campaign from 19.2% to 7.4% (p 0.001), and even fell below 1% in six provinces. Conclusion: This measles vaccination campaign improved overall vaccination coverage by 10% and reached more unvaccinated children. Efforts must continue to improve the retention of vaccination card, the adherence of unvaccinated children and the effectiveness of routine vaccination.
基金supported by the National Natural Science Foundation of China,No.81571046(to KZ)Key Project of Educational Department of Liaoning Province,No.LJKZ0755(to KZ)+2 种基金Project of Department of Science&Technology of Liaoning Province,No.2023JH2/20200116(to KZ)Shenyang Young and Middleaged Innovative Talents Support Program,No.RC210240(to KZ)the 345 Talent Project of Shengjing Hospital of China Medical University(to LH)。
文摘Amyloid-beta clearance plays a key role in the pathogenesis of Alzheimer's disease.H oweve r,the variation in functional proteins involved in amyloid-beta clearance and their correlation with amyloid-beta levels remain unclea r.In this study,we conducted meta-analyses and a systematic review using studies from the PubMed,Embase,Web of Science,and Cochrane Library databases,including journal articles published from inception to J une 30,2023.The inclusion criteria included studies comparing the levels of functional proteins associated with amyloid-beta clearance in the blood,cere b rospinal fluid,and brain of healthy controls,patients with mild cognitive impairment,and patients with Alzheimer's disease.Additionally,we analyzed the correlation between these functional proteins and amyloid-beta levels in patients with Alzheimer's disease.The methodological quality of the studies was assessed via the Newcastle-Ottawa Scale.Owing to heterogeneity,we utilized either a fixed-effect or random-effect model to assess the 95%confidence interval(CI)of the standard mean difference(SMD)among healthy controls,patients with mild cognitive impairment,and patients with Alzheimer's disease.The findings revealed significant alterations in the levels of insulin-degrading enzymes,neprilysin,matrix metalloproteinase-9,cathepsin D,receptor for advanced glycation end products,and P-glycoprotein in the brains of patients with Alzheimer's disease,patients with mild cognitive impairment,and healthy controls.In cerebrospinal fluid,the levels of triggering receptor expressed on myeloid cells 2 and ubiquitin C-terminal hydrolase L1 are altered,whereas the levels of TREM2,CD40,CD40L,CD14,CD22,cathepsin D,cystatin C,andα2 M in peripheral blood differ.Notably,TREM2 and cathepsin D showed changes in both brain(SMD=0.31,95%CI:0.16-0.47,P<0.001,I^(2)=78.4%;SMD=1.24,95%CI:0.01-2.48,P=0.048,I^(2)=90.1%)and peripheral blood(SMD=1.01,95%CI:0.35-1.66,P=0.003,I^(2)=96.5%;SMD=7.55,95%CI:3.92-11.18,P<0.001,I^(2)=98.2%)samples.Furthermore,correlations were observed between amyloid-beta levels and the levels of TREM2(r=0.16,95%CI:0.04-0.28,P=0.009,I^(2)=74.7%),neprilysin(r=-0.47,95%CI:-0.80-0.14,P=0.005,I^(2)=76.1%),and P-glycoprotein(r=-0.31,95%CI:-0.51-0.11,P=0.002,I^(2)=0.0%)in patients with Alzheimer's disease.These findings suggest that triggering receptor expressed on myeloid cells 2 and cathepsin D could serve as potential diagnostic biomarkers for Alzheimer's disease,whereas triggering receptor expressed on myeloid cells 2,neprilysin,and P-glycoprotein may represent potential therapeutic targets.
文摘The Fe_(1−x)Ni_(x)VO_(4)(x=0,0.05,0.10,and 0.20)nanoparticles in this work were successfully synthesized via a co-precipitation method.The structural,magnetic and electrochemical properties of the prepared Fe_(1−x)Ni_(x)VO_(4) nanoparticles were studied as a function of Ni content.The experimental results show that the prepared Ni-doped FeVO_(4) samples have a triclinic structure.Scanning electron microscopy(SEM)images reveal a decrease in average nanoparticle size with increasing Ni content,leading to an enhancement in both specific surface area and magnetization values.X-ray absorption near edge structure(XANES)analysis confirms the substitution of Ni^(2+)ions into Fe^(3+)sites.The magnetic investigation reveals that Ni-doped FeVO_(4) exhibits weak ferromagnetic behavior at room temperature,in contrast to the antiferromagnetic behavior observed in the undoped FeVO_(4).Electrochemical studies demonstrate that the Fe_(0.95)Ni_(0.05)VO_(4) electrode achieves the highest specific capacitance of 334.05 F·g^(−1) at a current density of 1 A·g^(−1),which is attributed to its smallest average pore diameter.In addition,the enhanced specific surface of the Fe_(0.8)Ni_(0.2)VO_(4) electrode is responsible for its outstanding cyclic stability.Overall,our results suggest that the magnetic and electrochemical properties of FeVO_(4) nanoparticles could be effectively tuned by varying Ni doping contents.
基金supported by the Science Achievement Scholarship of Thailand (SAST)the support of Office of Atom for Peace,Thailand and Thailand Institute of Nuclear Technology (a public organization) for providing facilities for some experiment in this work。
文摘The fossil shells on the sedimentary rocks were collected from The Historical Park,Ban Sap Noi Geopark,Phetchabun Province,Thailand.However,the fossils remained in this area were investigated on the characteristic species only in geological studies with taxonomy for fossil age predicting.To fill up the gap of these studies,the material characterization techniques were used to study the chemical composition and structure of fossil shells I,II and III.The results clearly showed that the morphologies of all fossil shells were Brachiopod fossils with different species.The functional group and elemental composition of all fossil shells showed that the high content of calcium carbonate was a major composition.In addition,the high content of quartz indicated the silica precipitation phenomenon in all fossil shells.The element composition of cross-sectional morphology and energy dispersive spectroscope (EDS mapping) were used to confirm the presence of Si element in each zone of fossil shells.The crystal structures of all fossil shells were investigated and indicated that the calcium carbonate compound was a calcite phase and silicon dioxide compound was a quartz phase.Moreover,the crystal structure of quartz phase was used to calculate the crystallinity index.The crystallinity index values in all fossil shells indicated a well-crystallized quartz.The age of fossil shells was estimated and found to be brachiopod fossil in carboniferous period with the age of about 359.2 to 299.0 million years.
基金supported by Faculty of MedicineChiang Mai University+2 种基金supported by the National Center for Advancing Translational SciencesNational Institutes of Healththrough grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH。
文摘BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.
