Health Services Research and Managerial Epidemiology最新文献

Introduction: Multimorbidity is a rising health issue globally and it is likely to become challenging in developing countries like Nigeria as they experience economic, demographic, and epidemiological transition. Yet, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. This study aims to systematically review studies of the prevalence, patterns, and determinants of multimorbidity in Nigeria.

Methods: Studies were identified by searching 5 electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Africa Index Medicus/Global Index Medicus). Multimorbidity as well as other versions of it was used to search. The prevalence and determinants were also searched. According to preestablished inclusion criteria, and using different search strategies, 6 articles were included. The quality and risk of bias were assessed using Joanna Briggs Institute appraisal tool for prevalence studies. Two researchers assessed the eligibility of studies for inclusion. The protocol was registered on PROSPERO Ref no. CRD42021273222. The overall prevalence, pattern, and determinants were analyzed.

Results: We identified 6 eligible publications describing studies that included a total of 3332 (men 47.5%, women 52.5%) patients from 4 states plus the federal capital territory Abuja. The multimorbidity prevalence ranges from 27% to 74% among elderly Nigerians. Cardiovascular together with metabolic and/or musculoskeletal conditions were the frequent patterns of multimorbidity. A positive association was observed between age and multimorbidity in most studies. Other factors associated with multimorbidity were female gender, low education status, poor monthly income/unemployment, hospitalization, medical visits, and emergency services.

Conclusion: There has been a growing need for more applied health services research to understand better and manage multimorbidity in developed countries. The scarcity of studies in our review reveals that multimorbidity is not a priority area of research in Nigeria, and this will continue to hinder policy development in that area.

Background: The bacterium Streptococcus pneumoniae commonly causes severe bacterial illnesses in both children and adults. S. pneumoniae is the most fatal bacterial pathogen, causing 50% of the deaths from lower respiratory infections in people of all ages.

Objectives: This study was aimed to determine a nasopharyngeal carriage rate of S. pneumoniae, related risk factors, and antibiotic susceptibility among prisoners in Hawassa Central Prison Institute Hawassa, Ethiopia.

Methods: From July to August 2021, a cross-sectional investigation was carried out in Hawassa prison. All randomly chosen adult volunteers were a part of the study. In this study, about 330 different people were included. Within 3 h of collection, the swab specimen was inoculated onto 5% sheep blood agar; the inoculated medium was then incubated for 18-24 h at 35-37 °C in a CO₂-enriched environment. Following incubation, the S. pneumoniae colonies were suspected, but the usual colony shape, alpha-hemolysis, Gram staining, optochin susceptibility, and bile solubility test allowed for confirmation. Antimicrobial susceptibility testing was carried out in accordance with the Clinical and Laboratory Standards Institute's guidelines.

Results: Overall carriage rate of S. pneumoniae among adult individuals were 41 (12.7%). The carriage rate of S. pneumoniae was affected by age classes that 39-48 years (OR = 4.82, 95%CI = 1.49-15.56, p = .009), 49-58 years (OR = 5.27, 95%CI = 1.27-21.89, p = .022), and greater than 58 years (OR = 4.36, 95%CI = 1.13-16.90, p = .033); cigarette smoking (OR = 3.41, 95%CI = 1.16-10.01, p = .026); and sharing beds (OR = 3.91, 95%CI = 1.27-12.07, p = .018). The majority of the isolates are susceptible for clindamycin (87.8%) and resistant for chloramphenicol (56%). Multidrug resistance was observed in 36.7%.

Conclusions: The overall carriage rate of S. pneumoniae was 12.7%. Age, cigarette smoking, and sharing beds in the same prison room had a substantial impact on this nasopharyngeal carriage rate. Chloramphenicol (56%), erythromycin (41.5%), tetracycline (39%), and co-trimoxazole (34.1%) resistance were seen in the majority of S. pneumoniae isolates. Early detection, hygiene maintenance, and appropriate treatment are necessary.

Background: Malaria infection remains one of the major global and national public health threats, affecting millions of people yearly by causing substantial morbidity and mortality. In developing countries, higher proportions of poor malaria prevention and control measure both regionally and nationally, particularly in pastoral community areas of southern Ethiopia.

Objective: The study aimed to assess malaria preventive practices and associated factors among households of pastoral communities in Borena zone, Oromia regional state, Southern Ethiopia, 2022.

Methodology: A community-based cross-sectional study design was used from March first to 30, 2022, among 421 selected simple random sampling households in pastoral communities of the Borena zone. Data were collected through face-to-face interviews with a structured pretested questionnaire and visual observation for household malaria prevention practices. Then, the data were analyzed using SPSS version 25. Bivariate and multivariable logistic regression analyses were used to identify factors associated with malaria preventive practices. Finally, adjusted odd ratio (AOR) together with 95% confidence intervals was used, and a P value of less than 0.05 indicated an overall statistical association.

Result: The overall malaria prevention rate among pastoral community households was 31.6%(133) [95%; CI = 27.2-36.4]. The factors significantly associated with malaria prevention practice were malaria prevention knowledge [AOR = 1.6, 95% CI = 1.1-2.5] and the absence of plasmodium parasites among children [AOR = 4.3, 95% CI = 2.8-8.7]. However, households staying outdoors at night [AOR = 0.5, 95% CI = 0.3-1.0] were negatively associated with household malaria prevention. A total of 200 (47.5%) households had used insecticide-treated mosquito nets (ITN) and 5(1.2%) households had indoor residual sprays (IRS).

Conclusion: The study revealed lower malaria prevention practices among households of the pastoral community. The government and other concerned bodies should contribute to malaria prevention measures in pastoral remote areas. Health extension workers should have to create awareness in the communities to avoid incorrect use of the ITN.

Background: Few models exist that incorporate measures from an array of individual characteristics to predict the risk of COVID-19 infection in the general population. The aim was to develop a prognostic model for COVID-19 using readily obtainable clinical variables.

Methods: Over 74 weeks surveys were periodically administered to a cohort of 1381 participants previously uninfected with COVID-19 (June 2020 to December 2021). Candidate predictors of incident infection during follow-up included demographics, living situation, financial status, physical activity, health conditions, flu vaccination history, COVID-19 vaccine intention, work/employment status, and use of COVID-19 mitigation behaviors. The final logistic regression model was created using a penalized regression method known as the least absolute shrinkage and selection operator. Model performance was assessed by discrimination and calibration. Internal validation was performed via bootstrapping, and results were adjusted for overoptimism.

Results: Of the 1381 participants, 154 (11.2%) had an incident COVID-19 infection during the follow-up period. The final model included six variables: health insurance, race, household size, and the frequency of practicing three mitigation behavior (working at home, avoiding high-risk situations, and using facemasks). The c-statistic of the final model was 0.631 (0.617 after bootstrapped optimism-correction). A calibration plot suggested that with this sample the model shows modest concordance with incident infection at the lowest risk.

Conclusion: This prognostic model can help identify which community-dwelling older adults are at the highest risk for incident COVID-19 infection and may inform medical provider counseling of their patients about the risk of incident COVID-19 infection.

Background: Self-triage is becoming more widespread, but little is known about the people who are using online self-triage tools and their outcomes. For self-triage researchers, there are significant barriers to capturing subsequent healthcare outcomes. Our integrated healthcare system was able to capture subsequent healthcare utilization of individuals who used self-triage integrated with self-scheduling of provider visits.

Methods: We retrospectively examined healthcare utilization and diagnoses after patients had used self-triage and self-scheduling for ear or hearing symptoms. Outcomes and counts of office visits, telemedicine interactions, emergency department visits, and hospitalizations were captured. Diagnosis codes associated with subsequent provider visits were dichotomously categorized as being associated with ear or hearing concerns or not. Nonvisit care encounters of patient-initiated messages, nurse triage calls, and clinical communications were also captured.

Results: For 2168 self-triage uses, we were able to capture subsequent healthcare encounters within 7 days of the self-triage for 80.5% (1745/2168). In subsequent 1092 office visits with diagnoses, 83.1% (891/1092) of the uses were associated with relevant ear, nose and throat diagnoses. Only 0.24% (4/1662) of patients with captured outcomes were associated with a hospitalization within 7 days. Self-triage resulted in a self-scheduled office visit in 7.2% (126/1745). Office visits resulting from a self-scheduled visit had significantly fewer combined non-visit care encounters per office visit (fewer combined nurse triage calls, patient messages, and clinical communication messages) than office visits that were not self-scheduled (-0.51; 95% CI, -0.72 to -0.29; P < .0001).

Conclusion: In an appropriate healthcare setting, self-triage outcomes can be captured in a high percentage of uses to examine for safety, patient adherence to recommendations, and efficiency of self-triage. With the ear or hearing self-triage, most uses had subsequent visit diagnoses relevant to ear or hearing, so most patients appeared to be selecting the appropriate self-triage pathway for their symptoms.

Background: Hand washing is the simplest, most affordable, and most effective means of limiting the spread of infections. Despite increasing efforts to improve hand washing at critical times (after defecation, after handling child/adult feces or cleaning child's bottom, after cleaning the environment, before preparing food, and before eating food), mothers/caregivers of under-five children fail to conduct it; but the reason appears unclear. Thus, this study sought to identify hand washing at critical times and associated factors among mothers/caregivers of under-five children in Nefas Silk Lafto Sub-City, Addis Ababa, Ethiopia.

Methods: A facility-based cross-sectional study was conducted on April 1-15, 2019, and 312 mothers/caregivers participated. A pretested questionnaire was used to collect data from participants by interviewer-administered technique and the data were analyzed with the Statistical Package for Social Science version 20. The factors were determined by conducting logistic regression and the crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals. All statistical tests were conducted at a 5% level of significance.

Results: The study revealed that 232 (74.4%; 95% CI [69.6%-79.2%]) mothers/caregivers washed their hands at critical times. The illiterate mothers/caregivers and mothers/caregivers who lacked tap water inside the home or the backyard had 66% (AOR = 0.34; 95%CI [0.17-0.69]) and 62% (AOR = 0.38; 95%CI [0.18-0.80]) reduced odds of washing hands at critical times, respectively. Mothers/caregivers from middle had (AOR = 4.56; 95%CI [1.84-11.33]), richer had (AOR = 5.61; 95%CI [2.11-15.30]), and the richest had (AOR = 6.14; 95%CI [2.24-16.72]) times increased likelihood of washing hands at critical times than the poorest.

Conclusion: The majority of mothers/caregivers practiced hand washing at critical times, and improving maternal literacy, household economy, and availability of water sources in the backyard are needed to maintain and enhance the practice.

Background: The prevalence and determinants of antenatal care (ANC) dropout in Ethiopia were studied. However, the results were inconsistent and showed considerable variation. Hence, this meta-analysis aimed at estimating the overall prevalence of ANC dropout and its predictors in Ethiopia.

Methods: A comprehensive search of published studies was done using different international databases such as such as PubMed, DOJA, Embase, Cochrane Library, Google Scholar, and the institutional repository of Ethiopian universities were used to search for relevant studies. Data were extracted using Microsoft Excel spreadsheet, and exported to STATA v17 for analysis. A random effect model was used to estimate the overall national prevalence of ANC dropout. Fixed effects model were used to compute the pooled adjusted odd ratios (AOR) with the corresponding 95% confidence intervals (CIs). I ² test was used to assess heterogeneity of the included studies. Egger's tests was used to check for the presence of publication bias.

Results: A total of 7 studies were included in this systematic review and meta-analysis with 11,839 study participants. The overall pooled prevalence of ANC in Ethiopia was found to be 41.37% (95% CI =35.04, 47.70). Distance from the health care facility (AOR = 2.93, 95% CI = 2.75, 3.11), pregnancy complication signs (AOR = 2.97, 95% CI = 2.77, 3.16), place of residence (AOR =  1.79, 95% CI = 1.31, 2.26), educational level (AOR = 1.79, 95%CI = 1.37, 2.21), and age group (30-49) (AOR = 0.61, 95% CI = 0.45, 0.78) were significantly associated with ANC dropout.

Conclusion: Based on this review and meta-analysis, 41% of Ethiopian women dropped out of ANC visits before the minimum recommended visit (4 times). Hence, to reduce the number of ANC dropouts, it is important to counsel and educate women during their first prenatal care. Issues of urban-rural disparities and noted hotspot areas for ANC dropout should be given further attention.

Background: Chronic undernutrition (stunting) among children is associated with an increased risk of morbidity and mortality. The global community is committed to end all forms of malnutrition by 2030. Regardless of this, children are suffering from some form of malnutrition but the reason is unclear. This study thus was intended to identify stunting and associated factors among children aged 6 to 59 months in the South Ari Woreda of South Omo Zone.

Methods: A community-based cross-sectional study was conducted in South Ari Woreda from 1, January 2022 to 30, February 2022, and 409 children participated. A simple random sampling technique was used to identify study participants, and mothers/caregivers were interviewed. Data on sociodemographic, economic, and environmental determinants were collected by trained professional nurses using interviewer-administered questionnaires and anthropometric data were collected via weighting and measuring the height/length of the child. Emergency Nutrition Assessment for Standardized Monitoring and Assessment of Relief and Transitions 2020 software was used to generate an anthropometric index, and a child with a height for age index below -2standard deviations of the standard population was considered stunted. Factors of stunting were assessed using multivariate binary logistic regression at a 5% significance level.

Results: The study revealed that 44.0% (95% confidence interval (CI) = 39.19%-48.81%) of children were stunted in the study area. Household's wealth status (the poorest; adjusted odds ratio (AOR) = 4.14 [95% CI = 2.08-8.22] and poor; AOR = 3.31 [95% CI = 1.60-6.82]), improper solid waste management practice of the household (AOR = 2.67 [95% CI = 1.56-4.55]), and the children sleeping under insecticide-treated bed nets (ITN) (AOR = 0.37 [95%CI = 0.22-0.60]) were statistically significantly associated with stunting status of the children.

Conclusion: Stunting among the children in the study area was very high. Improving household's (HH) economy, safe management of domestic solid waste, and ensuring that the children are sleeping under ITNs are expected to reduce stunting.

Objectives: Substance-dependency is a significant health problem that might affect couples' relationships and lead to several complications such as burnout. This study aimed to assess and compare couple burnout in women with and without substance-dependent partners.

Methods: In this cross-sectional study samples of women with and without substance-dependent partners were studied. Couple burnout was assessed using the Couple Burnout Measure (CBM). The data then were compared between the study groups by performing descriptive statistics, independent t-test, and chi-square. Logistic regression analysis was carried out to examine the association between couple burnout and independent variables.

Results: In all 264 women with (n = 121) and without (n = 143) substance-dependent partners were studied. Couple burnout was assessed using the Couple Burnout Measure (CBM). There were significant differences between both groups in most characteristics. The mean score of couple burnout in women with and without substance-dependent partners were 3.8 ± 1.2 and 2.6 ± 0.85 respectively (p < 0.001). In logistic regression analysis, the probability of couple burnout in women with substance-dependent partners was 4.5 times more than those without substance-dependent partners (OR = 4.50, CI = 2.48-8.17, p < 0.001).

Conclusion: The findings showed that women with substance-dependent partners might suffer from higher couple burnout. Indeed, implementing appropriate interventions such as educational and counseling programs in health centers and substance abuse treatment centers is recommended. In fact, the current study highlights the extra burden that women with substance-dependent partners experience.

Background: In California, laboratories report all hepatitis C (HCV)-positive antibody tests to the state; however, that does not accurately reflect active infection among those patients without a viral load test confirming a patient's HCV diagnosis. These public health surveillance disease incident records do not include patient details such as comorbidities or insurance status found in electronic medical records (EMRs).

Objective: This research seeks to understand how insurance type, insurance status, patient comorbidities, and other sociodemographic factors related to HCV diagnosis as defined by a positive viral load test among HCV antibody-positive persons from January 1, 2010 to March 1, 2020.

Methods: HCV antibody-positive individuals reported to the California Reportable Disease Information Exchange (CalREDIE), with a medical record number associated with the University of California, Irvine Medical Center, and an unrestricted EMR (n = 521) were extracted using manual chart review.

Main outcomes and measures: HCV diagnosis as indicated in a patient's EMR in the problem list or disease registry.

Results: Less than a quarter of patients in this sample were diagnosed as having HCV in their EMR, with 0.4% of those diagnosed (5/116) patients with indicated HCV treatment in the medication field of their charts. After adjusting for multiple comorbidities, a multinomial logistic regression found that the relative risk ratios (RRRs) of HCV diagnosis found that patients with insurance were more likely to be diagnosed compared to those without insurance. When comparing uninsured patients to those with government insurance at the P < .05 level (RRR = 10.61 (95% confidence interval (CI): 4.14-27.22)) and those uninsured to private insurance (RRR = 6.79 (95% CI: 2.31-19.92).

Conclusions: These low frequencies of HCV diagnosis among the study population, particularly among the uninsured, indicate a need for increased viral load testing and linkage to care. Reflex testing on existing samples and improving HCV screening and diagnosis can help increase linkage to care and work towards eliminating this disease.