WHO South-East Asia journal of public health最新文献

Background: In Bhutan, the maternal mortality rate has drastically decreased over the years. In situations where maternal mortality is not a public health concern anymore, severe maternal conditions have been used as an alternative to maternal health quality indicators.

Aims and objectives: This study aimed to report the prevalence, underlying causes, and outcomes of maternal near-miss (MNM) cases in Bhutan.

Materials and methods: The study involved a secondary analysis of routine data on MNM cases recorded in three referral hospitals in Bhutan from 2018 to 2020. The World Health Organization MNM, 2011 approach guided the investigation.

Results: The incidence of potentially life-threatening conditions was 12.8 and MNM was 6.7 per 1000 live births. Obstetric hemorrhage, pregnancy with abortive outcomes, and hypertensive disorders in pregnancy were some of the leading conditions, which had led to women experiencing near-miss complications. About 68.5% of women had received blood products, 20.2% had undergone laparotomy, and 5.9% required intensive care unit admission.

Conclusion: An audit of MNM cases, which occur more frequently than maternal deaths, could provide better insights into the existing quality of care.

Background: There is a need to institutionalize respectful maternity care (RMC) as a standard of care in public health systems.

Aim and objectives: This study demonstrates the development, implementation, and impact of an intervention package for providing RMC to women availing antenatal, natal, and postnatal services.

Methodology: An intervention package was developed in consultation with healthcare providers incorporating, (a) capacity-building workshops to empower healthcare staff, (b) mentoring support for developing action plans, and (c) development of behavior change communication material. Key practices such as allowing birth companions and the development of consent forms for different procedures were institutionalized. Baseline (January 2018) and endline (March 2020) evaluations were conducted using mixed methods in the department of obstetrics and gynecology at a medical college in Maharashtra, India. Exit interviews with 100 antenatal women, in-depth interviews (IDIs) with postnatal women (19 in baseline and 8 in endline), and 16-h of labor room observations were conducted.

Results: Of the 35 types of disrespect and abuse (D and A) instances, 20 were reported by atleast two methods (any two out of exit interviews/IDIs/labor room observations) - hence considered "definite." A significant improvement was observed in nine types of D and A. However, 11 types of D and A such as issues in providing verbal comfort, using curtains and drapes for examination, provision of changing rooms, taking informed consents for the procedures, and attending to women at her call were still reported/observed at the endline. The interventions led to improved service delivery.

Conclusions: Written policies and procedures, regular training, focused interventions, and using behavior change communication materials have the potential to enhance RMC. However, despite the interventions, many instances of D and A persisted indicating it to be a systemic problem.

Background: Indonesia faces the challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health status. By examining the distribution patterns and identifying the areas of critical need, the study seeks to inform policy interventions that can more effectively address the health worker (HW) distribution.

Methods: We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of HWs: General practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the HW-to-population ratio to quantify the availability of healthcare workers. We employed the Gini Index as a measure of distribution equality. In addition, we conducted a comparative metric approach to assess the quantity and the equity of healthcare worker distribution across the districts.

Results: In Indonesia, the current HW ratio stands at 3.84 per 1000 people, falling short of the World Health Organization's threshold of 4.45 for achieving 80% universal health coverage. This shortfall translates to a need for an additional 166,000 HWs. While midwives show a relatively equitable distribution, specialists and dentists exhibited significantly unequal distribution, especially at the district level. There were greater disparities at the district than at the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals.

Conclusion: This study shows that human resources for health in Indonesia are both inadequate in terms of quantity, and unevenly distributed. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle each region's unique problems.

Abstract: Nurse-led interventions are tailored to the specific needs of heart failure (HF) patients, facilitating the transfer of knowledge in ways that are more feasible and applicable within the context of diverse healthcare settings. These programs emphasize comprehensive discharge planning, patient education on self-care practices, medication management, and early symptom recognition. The meta-analysis included 11 randomized controlled trials, selected from databases including MEDLINE, EBSCO, CINAHL, and the Cochrane Library. Quality assessment of the included studies was conducted independently by two reviewers. The overall pooled effect showed a relative risk (RR) of 0.69 (95% confidence interval [CI]: 0.54-0.89) for all-cause readmission and a RR of 0.80 (95% CI: 0.71-0.91) for combined outcomes of all-cause readmission and mortality in the nurse-led group compared to the control group. These results indicate that nurse-led transitional care interventions contribute substantially to reducing both readmission rates and mortality among HF patients. The review also explored the applicability of these interventions in low-resource settings, emphasizing their potential to be adapted and implemented effectively in lower-middle-income countries. This review highlights the pivotal role of nurse-led transitional care programs in addressing these challenges by providing close support to patients and their families. Leveraging existing resources and fostering interdisciplinary collaboration are essential in optimizing healthcare delivery in low-resource settings.

Background: Nonstandard pharmaceutical or manufacturer labels may lead to medication errors. Therefore, label content and design are specified and monitored through regulatory frameworks. The aim of this study was to assess the availability of vital information in manufacturer labels of medicines used in a selected state hospital and adherence to the guidelines on labelling of medicines (GLM V1.0) of the National Medicines Regulatory Authority (NMRA), Sri Lanka.

Methods: Three hundred randomly selected medicine manufacturer labels were assessed using a checklist developed based on GLM V1.0.

Results: Of the 300 labels, 89.6% complied with the recommended format of the generic name followed by its pharmaceutical form and strength, and 84.0% specified their pharmacopeial monograph. Almost 40% were substandard, lacking at least one essential piece of information required by regulation. The strength of the medicine was not indicated in the principal display panel (PDP) of 5.3% of medicines. 5.0% of labels for various strengths of the same medicine or different medicines looked alike. Other observed flaws were missing necessary information and look-alike labels, reflecting a lack of quality control.

Conclusion: Divergence from specified standards demonstrates the need for a multifaceted approach by the NMRA to prevent ambiguous labels. Key calls to action for policymakers include better manufacturer guidance, stronger pre-submission assessments, rejecting non-standard labels, and introducing barcode readers.

Abstract: Equity-informative Cost-Effectiveness Analysis (CEAs) can promote fair healthcare access, yet their use in the WHO South-East Asia region (SEARO) is not well understood. This study aims to summarize methodological approaches, equity-relevant groups, health inequality measures, and healthcare provision areas addressed in equity-informative CEAs in SEARO countries. A systematic search was conducted in PubMed, Embase, Scopus, and Tufts CEA registry for equity-informative CEAs from WHO SEARO countries (2014-2023). CEAs with at least two alternative interventions and one equity criterion were included. Data extraction used Microsoft Excel. Interventions' distributional effects on cost-effectiveness were evaluated qualitatively, and bias was assessed using the CHEERS checklist. Of 828 studies identified, 10 were selected, nine from India (90%) and eight between 2014-2017 8 (80%). Studied groups included children, patients, the general population, adolescent girls, and neonates. All studies used cost-effectiveness analysis; 8 (80%) focused on healthcare providers' perspectives. Disability-Adjusted Life Years (DALYs) were primary outcome measures in 8 (80%) studies, while 9 (90%) assessed financial risk protection via out-of-pocket expenditure averted. Wealth quintiles were the equity criterion in 9 (90%) studies. About 6 (60%) conducted subgroup analyses and Extended Cost-Effectiveness Analyses (ECEA), with 2 (20%) using the Gini coefficient. Most studies 9 (90%) demonstrated 'greater value,' indicating improved public health implications. The scarcity of equity-informed CEAs in SEARO countries, excluding India, underscores the need for broader adoption. Improved public health implications highlight the necessity of equity-informed CEAs. Addressing these issues is essential to advance health equity in the SEARO region.