BackgroundMaternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation’s lowest scores on key development and health indicators and presents a substantial challenge to Uganda’s stability and poverty eradication ambitions. The objectives of this study were: to establish the availability of maternal and neonatal healthcare services at different levels of health units; to assess their utilisation; and to determine the quality of services provided.MethodsA cross sectional study of all health facilities in Napak and Moroto districts was conducted in 2010. Data were collected by reviewing clinical records and registers, interviewing staff and women attending antenatal and postnatal clinics, and by observation. Data were summarized using frequencies and percentages and EmOC indicators were calculated.ResultsThere were gaps in the availability of essential infrastructure, equipment, supplies, drugs and staff for maternal and neonatal care particularly at health centres (HCs). Utilisation of the available antenatal, intrapartum, and postnatal care services was low. In addition, there were gaps in the quality of care received across these services. Two hospitals, each located in the study districts, qualified as comprehensive EmOC facilities. The number of EmOC facilities per 500,000 population was 3.7. None of the HCs met the criteria for basic EmOC. Assisted vaginal delivery and removal of retained products were the most frequently missing signal functions. Direct obstetric case fatality rate was 3%, the met need for EmOC was 9.9%, and 1.7% of expected deliveries were carried out by caesarean section.ConclusionsTo reduce maternal and newborn morbidity and mortality in Karamoja region, there is a need to increase the availability and the accessibility of skilled birth care, address the low utilisation of maternity services and improve the quality of care rendered. There is also a need to improve the availability and accessibility of EmOC services, with particular attention to basic EmOC.
IntroductionThis study aimed to evaluate the long-term retention of knowledge, skills, and competency of health workers who completed a Helping Babies Breathe (HBB) training program and its effect on newborn mortality.MethodsA quasi-experimental pre- and post-intervention study was conducted. Participants were health workers selected based on their previous training on HBB protocols. Participants were assessed for knowledge, skills, and competency in March 2017 (immediately before and after training), June 2017 (three months after training), and September 2018 (one year after training). Assessments were conducted using HBB questionnaires, checklists and practical skill drills. Mean scores were obtained and ANOVA, chi-squared test, and Pearson's test were used for pre intervention, post intervention, and one-year-after comparisons. The effect of training on the management of newborn asphyxia was assessed based on a review of the delivery registry at a maternity and children's ward. The scores were group into percentages and averages means and were computed using chi-squared tests.ResultsDespite improvements in knowledge, skills, and competency three months after training, participants showed a marked decline one year after training. Knowledge increased from 42.5% pretest to 97% posttest but decreased to 84.5% three months' post training and further decreased to 69.4% one year post training. Skills increased from 26.1% pretest to 94.4% posttest, remained at 94.4% at three months, and decreased to 77.0% at one year. Simple resuscitation scores increased from 26.9% to 88.8% pre- and posttest, remained roughly at three months and decreased to 76.4% at one year. For complex resuscitation, scores decreased from 90.9% posttest to 76.9% at one year. The assessments at one year indicated a need for support and practice, especially with bag-mask ventilation.ConclusionThe immediate evaluation of health workers after HBB training showed significant increases in knowledge, skills and competency in neonatal resuscitation. However, this declined after one year. The training also resulted in decreased neonatal mortality.
Objective This study aimed at investigating the effectiveness of a robotic fall prevention program on knowledge, exercises, balance, and incidence of falls among elderly in senior housings. Patients and methods This is a quasi-experimental study. Sixty-four elderly in two senior housings in Bangkok with Barthel Index scale ≥12, who had either at least one fall experience in the past 12 months and/or had Timed Up and Go (TUG) test ≥20 seconds were recruited and purposively assigned to the intervention group (received a small robot-installed fall prevention software, personal coaching, and handbook, n=32) and control group (received only handbook, n=32). Outcomes were knowledge score evaluated by structured questionnaire through face-to-face interviews, number of exercises measured by self-recorded diary, and balance score assessed by TUG and Berg Balance Scale (BBS). The incidence of falls was assessed by face-to-face interviews. Both groups were assessed at baseline, 3rd, and 6th month after the intervention. Results There was a statistically significant improvement in knowledge mean score at 6th month in both the groups. However, the intervention group showed faster increase in knowledge mean score than the control group at 3rd month ( P <0.01). The intervention group showed a statistically significant higher number of exercises than the control group at 3rd and 6th month ( P <0.05). There was no statistically significant difference on TUG and BBS mean scores between the two groups at baseline, 3rd, and 6th month. However, the intervention group showed a statistically significant improvement in TUG and BBS at 6th month post-intervention ( P <0.01). There was one fall reported in the control group. Conclusion The robotic fall prevention program increased knowledge on fall prevention and promoted exercises and balance among elderly in senior housings.
Most low and low-middle income countries adopting National Health Insurance (NHI) programs to achieve Universal Health Coverage are struggling to implement the program due to underlying problems at implementation. However, there is a lack of research that focuses on these problems. The Nepal NHI program initiated in 2016 has experienced numerous implementation challenges. This qualitative study delves into the NHI program's inputs and throughputs/implementation bottlenecks. The study based in Nepal's four districts included 28 in-depth interviews, six focus group discussions, and identified 12 themes that pointed to the NHI program's inadequate inputs causing bottlenecks. The analysis employed the Grounded Theory. The main challenges identified were insufficiently defined NHI implementations guidelines, conflicting Act clauses, a lack of HIB organizational guidelines, and inadequate human resources.The major throughput bottlenecks were difficulty enrolling the insurees, the inability to select the health providers competitively and to act as a prudent purchaser of the services.These inadequate inputs and throughput bottlenecks led to negative outputs such as insurees' high dropouts, and low coverage of poor households. The NHI program's sustainability might be at stake if the identified problems persist, further exacerbated by the plummeting economic situation in the country due to COVID-19.
Expanding membership coverage and retention of the National Health Insurance (NHI) programs among informal sector workers (ISWs) continues to be a significant challenge in most low and lower-middle-income countries (LMICs). The Nepal NHI program is also facing a similar problem, but to date, there are no studies that focus on identifying key predictors of annual membership renewal and retention in Nepal. This study therefore aimed to determine the predictors of intention to renew annual subscription to the NHI program among enrolled members. This cross-sectional quantitative study was part of a larger mixed-methods study conducted in three districts in Nepal. A random sample of 182 current NHI members and 61 dropped out NHI members who met the inclusion criteria were interviewed. The study’s dependent variable was the intention to renew annual membership and employed univariate regression to assess the bivariate associations with the independent variables. The multivariate logistic regression examined the net effect of the independent variables on the odds of intention to renew. Our results showed that the household (HH) with high monthly income had lower odds of renewing their annual NHI membership (adjusted OR: 0.14, 95% CI: 0.03–0.58). Similarly, households (HHs) with overall health service satisfaction (adjusted OR:3.59, 95%CI: 1.23–10.43) and increased frequency of visits after NHI membership (adjusted OR: 10.09, 95% CI: 1.39–73.28) had high odds of renewing their membership. The top three dropout reasons were health services underutilization (43.3%), poor health services (26.9%), and the inadequacy of the benefits package (14.9%). Almost 64% of the respondents were willing to renew their membership upon improved services. The study found that the Nepal NHI annual membership renewal key predictors are HH income, health service quality, and health service utilization. Among these three key predictors, health service quality and service utilization were among the top three dropout reasons. The study, however, did not differentiate between moral hazards or actual service utilization, demanding further studies on the health service utilization of the insured members.
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