Schistosomiasis causes substantial chronic morbidity in sub-Saharan Africa, yet case definitions, clinical management guidance, and health worker training for schistosomiasis-related morbidity remain limited. We conducted a qualitative needs assessment for schistosomiasis morbidity management. Workshops were held over one day in each of Pakwach, Buliisa, and Mayuge Districts in Uganda in October 2024. 105 government health workers participated including clinicians, nurses, laboratory technicians, sonographers, and district health managers from health facilities at different levels of care. The workshops comprised six structured sessions: presentations on schistosomiasis burden in Uganda and the SchistoTrack cohort, a clinical case report by an expert clinician, an interactive session on patient case studies from the SchistoTrack cohort, mapping of patient pathways, anonymous participation and feedback, and demonstrations of schistosomiasis diagnosis. Workshop discussions were documented through notes taken in English and analysed using qualitative thematic analysis as per Braun and Clarke. Health workers demonstrated substantial gaps in understanding schistosomiasis case definitions, particularly in distinguishing current infection from chronic morbidity and in grading disease severity. Patient pathways for schistosomiasis morbidity management were fragmented and inconsistent, with weak triage, unclear referral and feedback mechanisms, and limited follow-up across facility levels. Health facilities lacked essential capacity and resources, including routine access to praziquantel outside mass drug administration, diagnostic reagents, functional ultrasound equipment, trained sonographers, and standardized training and reference tools. Collectively, these gaps contributed to inconsistent clinical decision-making and under-recognition of severe schistosomiasis-related morbidity. Integrating case management into routine health services through standardized case definitions, clearer patient pathways, and targeted practical training for health workers is essential to complement preventive chemotherapy and reduce preventable morbidity. The engagement framework and patient case studies used here can support needs-based assessments in other endemic settings to inform the development of context-appropriate clinical guidance and training programmes.
This study aimed to investigate the relationship between average travel time to healthcare facilities and management of type 2 diabetes mellitus (T2DM). In addition, we examined how average travel time and the presence of a usual source of care (USC) interact to influence T2DM management. We analyzed National Health Insurance data from 2015 to 2019 for a cohort of 81,588 patients newly diagnosed with T2DM in 2014. Geographic Information System-based road network data were used to calculate travel time. Outcome variables for T2DM management included regular visits, medication adherence, and monitoring tests: hemoglobin testing, lipid panel testing, and fundus examination. Generalized Estimating Equations models were used to assess the effects of travel time on T2DM management. Patients traveling ≤ 15 minutes to their healthcare facilities had higher rates of regular visits (risk ratio [RR], 1.04; 95% confidence interval [CI], 1.03-1.05), but showed no significant difference in medication adherence (RR, 1.00; 95% CI, 1.00-1.01) relative to patients with longer travel times. The presence of a USC was associated with higher levels of medication adherence (RR, 1.16; 95% CI, 1.15-1.16) and regular visits (RR, 1.38; 95% CI, 1.37-1.40). Patients with both a USC and short travel time had the highest medication adherence and visit rates (RR, 1.14 and 1.42) compared to those without a USC and with longer travel times, reflecting significant interaction effects. Shorter travel time was, however, associated with lower uptake of diabetes monitoring tests. Patients who most frequently visited tertiary or general hospitals had lower regularity of visits and medication adherence but higher rates of diabetes monitoring tests. This study highlights the importance of the combined effect of travel time and the presence of a USC in promoting regular visits to healthcare facilities among T2DM patients, rather than the effect of either factor alone. These findings underscore the need to consider both proximity and continuity of care when planning healthcare access strategies for T2DM management. In addition, measures are needed to promote the implementation of diabetes monitoring tests in clinics.
Acute kidney injury is a global health concern with significant implications for morbidity and mortality when it comes to children. High morbidity and mortality result from consequences such as metabolic acidosis, hyperkalaemia, fluid overload and cardiovascular issues. Good clinical outcomes among children with acute kidney injury can be achieved through early recognition and initiation of management to prevent disease progression. However, evidence on early recognition and management of acute kidney injury in children is lacking, especially in low-resource settings such as Tanzania. This study explores healthcare providers' experiences with early recognition and management of acute kidney injury among children attending primary healthcare facilities. This exploratory qualitative case study aims to capture contextual experiences using semi-structured interviews to gain thematic insights. The estimated sample size for this study is 20 informants and will be selected purposively. Data will be collected through individual interviews using an interview guide with predetermined questions followed by probing questions. Each interview session will last for about 30-60 min. Data analysis will begin during the data collection period using the six-phase thematic analysis approach by Braun and Clarke. Ethical approval has been provided by the Muhimbili University of Health and Allied Sciences Senate of Research and Ethical Committees with reference number DA.282/298/01.C/2630. In accordance with the Declaration of Helsinki (1964) and its later amendments, all respondents will provide verbal and written informed consent and will be free to participate voluntarily with no incentives. The findings will be shared with participating healthcare facilities, district and regional health authorities and relevant stakeholders through presentations and summary reports. Findings will also be presented at national and international scientific conferences and submitted for publication in peer-reviewed journals.
BackgroundMenstrual hygiene management (MHM) remains a neglected concern in Togo, despite its critical importance for the education, health, and dignity of girls and women. Neglecting MHM directly impacts women's reproductive morbidities that may adversely affect fertility outcomes. However, there is limited literature on MHM practices in Togo and their impact on individual fertility.ObjectivesThe study aims to examine the (1) effects of structural determinants-namely WASH infrastructure, socio-economic disparities, and social norms on menstrual hygiene practices, and (2) causal effect of MHM on reproductive health outcome, measured in terms of fertility of Togolese women. Considering the endogeneity of MHM, we aim to provide evidence that the roles of WASH facilities, social norms, and socio-economic factors influence MHM and thereby linking it directly to fertility of women.DesignThe study uses secondary data from a cross sectional survey of nationally representative Multiple Indicator Cluster Survey (MICS6, 2017) for Togo.MethodsWe have used control function (CF) approach to address the endogeneity of MHM to estimate the causal inference of MHM on the fertility of ever-married women aged between 15-49 years in Togo. The source of endogeneity of MHM is explained through the channels of social exclusion-related unobservable, and availability of WASH facilities.ResultsThe access to WASH facilities improve the probability of MHM by 31-53 percentage points. Our study establishes the existence of a strong causal relationship between MHM and fertility rate, establishing the endogeneity of MHM. The fertility increases (4-5%) significantly for women who manage their menstrual hygiene.ConclusionEffective MHM is crucial for individual dignity, health, and well-being. Our study indicates that proper menstrual hygeine management has significantly affect the reproductive health of women measured in terms of fertility. To foster an enabling environment of MHM concerned, the study recommended a few public policy interventions. Menstrual hygiene management remains a neglected concern in Togo. Neglecting menstrual hygiene directly impacts women’s reproductive health and is closely linked to gender equality and empowerment. However, there is limited literature on menstrual hygiene practices and their impact on fertility rates. Our study aims to fill this gap by providing evidence of the existence of a causal impact of self-reported menstrual hygiene management on the fertility rate of Togolese women. Using the Multiple Indicator Cluster Survey (MICS6) of Togo for 2017, our findings indicate the significance of access to water, hand-washing facilities, and cleaning supplies in improving menstrual hygiene management. Furthermore, we find that socioeconomic factors such as education level, family affluence, etc, influence women’s ability to manage their menstrual hygiene. Our study underscores the need for integrating menstrual hygiene into reproductive health policies and addressing key socio-economic and structural barriers that hinder proper menstrual hygiene management.
The coronavirus disease 2019 (COVID-19) pandemic has strongly challenged health systems, but Italian community mental health services, rooted in the Basaglia reform and the World Health Organization (WHO) QualityRights framework, may have preserved a high perception of care quality and respect for human rights. This study compared users' perceptions of quality of care, human rights, and resource adequacy in public mental healthcare facilities during and after the pandemic in Sardinia, Italy. A cross-sectional survey was conducted in 2025 among users attending three community mental health services (Nuoro and Sanluri Local Health Networks) and one university hospital facility (Cagliari). Data were compared with a previous survey carried out in the same network during the COVID-19 pandemic (2021). Users completed a brief sociodemographic form and the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR, user version), inspired by the United Nations (UN) Convention on the Rights of Persons with Disabilities and WHO QualityRights. Group differences were analyzed using chi-square tests and one-way analysis of variance (ANOVA). The final 2025 sample included 118 users, compared with 200 users in 2021. Mean satisfaction scores for overall care and organizational aspects (WWRR items 1-3) remained very high in both surveys (>5/6) without significant differences. Perceived respect for users' rights (item 4) and staff rights (item 5) significantly increased post-pandemic (5.26 ± 1.10 vs. 5.51 ± 0.98, p = 0.042; and 4.89 ± 1.22 vs. 5.35 ± 1.04, p = 0.001, respectively). Perception of resource adequacy (item 6, reverse-coded) also improved (2.68 ± 1.10 vs. 2.06 ± 0.98, p < 0.001), although it remained the most critical domain. Item 7 indicated an evolving demand for a more diversified workforce, with psychologists being the most frequently requested professionals, and an emerging perceived need to increase multiple professionals across multiple categories and administrative/management staff. Users of Sardinian community mental health services reported persistently high satisfaction and an increased perception of respect for human rights after the COVID-19 pandemic, despite ongoing concerns about limited resources. These findings highlight the resilience of community-based mental healthcare and underscore the need for structural investment and the strengthening of the multidisciplinary workforce strengthening to sustainably align service provision with international human rights standards.
Prevalence of common perinatal mental disorders (CPMDs) in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps exist across health systems levels. This paper reports a realist evaluation of an intervention which aimed to integrate screening for CPMDs using the Self Reporting Questionnaire 20 (SRQ 20) at antenatal care services in primary healthcare facilities in Bac Giang province, Vietnam. We conducted a realist evaluation of the intervention's implementation to understand the context, mechanisms and outcomes of integrated maternal mental healthcare provision at primary care level in Vietnam. We report results from a quantitative survey, qualitative focus groups and interviews with key health system actors and pregnant women. Survey results were analysed using the Kirkpatrick evaluation approach, and qualitative results were analysed retroductively against the initial program theory. The intervention was implemented over six months during May-October 2023. Over this period 1,265 pregnant women at the District Hospitals and 504 at the Commune Health Centers were screened using the SRQ-20, respectively. Maternity care providers recognized the importance of perinatal mental health and care provision at the primary care level. Their self-efficacy and confidence in CPMD management were enhanced after continuing medical education courses on mental health management. The intervention contributed to improve health systems responsiveness to mental health needs among pregnant women at primary healthcare facilities. Our work indicates that integrated screening of CPMDs using SRQ-20 into routine antenatal care services at the primary care level is feasible in Vietnam. The findings advance the understanding of the contexts, mechanisms, and outcomes of how the intervention works, and provide explanations for what is required for effective integration of perinatal mental health at primary care level in Vietnam.
Targets to achieve universal access to environmental health services include healthcare facilities. To support improvement efforts, the World Health Organization and UNICEF published the "Eight Practical Steps," a roadmap for countries to achieve universal access. This document provides clear directions, but many steps are ambitious, and countries' readiness to complete them is unclear. We conducted a qualitative study in 2023 to evaluate stakeholder readiness to implement the Eight Practical Steps and documented capacity development needs, using interviews with 43 participants. We applied an implementation science theory-organizational readiness for change-to structure our interviews around factors influencing readiness. Readiness was highest for conducting baseline situation assessments (Step 1), establishing standards (Step 3), improving infrastructure (Step 4), and strengthening the health workforce (Step 6). Readiness was enhanced by stakeholder cooperation, positive attitudes for change, and availability of tools for monitoring, risk assessment, and healthcare worker training. Capacity development was needed to tailor situation assessment tools, training materials, and standards for different contexts. Readiness for change was lower for developing costed roadmaps (Step 2), monitoring progress (Step 5), engaging communities (Step 7), and conducting operational research (Step 8). Stakeholders prioritized earlier steps and had not yet dedicated substantial effort or resources to later ones. Barriers included a lack of tools and guidance. Our results indicate enthusiasm and cooperation to improve environmental health services, but rapid action sometimes came at the expense of strategic planning and learning opportunities. We recommend strengthening funding, personnel, and technical support for planning, monitoring, evaluation, and operational research.
 The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool designed to help healthcare professionals enhance childbirth practices. We assessed the level of awareness, utilization, and barriers to utilization of the WHO SCC among obstetric health workers. An observational cross-sectional analytical study was conducted in facility-based public health institutions of Khordha district, Odisha, India. These were primary and secondary-level public health facilities providing 24-hour maternity services to low- and middle-income women from urban and nearby rural areas. The participants comprised all obstetric care providers working in maternity units and parturient women admitted to the labor unit of public health institutions in Khordha district. These included doctors, midwives, nurses, and community health officers. The primary outcome was to assess the level of knowledge and utilization of the WHO SCC among obstetric care providers at different public health institutions. The secondary outcomes were to identify the factors associated with knowledge and utilization of the WHO SCC and perceived barriers to non-utilization of the WHO SCC. The overall mean knowledge score of obstetric care providers regarding the WHO SCC was 14.40 ± 4.91, corresponding to a mean percentage score of 48.0%, indicating suboptimal knowledge. Bivariate logistic regression analysis demonstrated that higher age (OR = 2.51; 95% CI: 1.15-5.47), professional category, i.e., midwives (OR = 2.61; 95% CI: 0.98-6.94) and nursing officers (OR = 5.00; 95% CI: 1.10-22.82), previous formal training (OR = 2.55; 95% CI: 1.05-6.16), and more clinical experience (OR = 0.37; 95% CI: 0.16-0.90) were significantly associated with higher level of knowledge. The study further demonstrated moderate adherence (>70%) to recommended childbirth practices among providers who utilized the WHO SCC in routine labor room practice. Higher adherence was observed for key practices such as allowing a birth companion, maternal blood loss assessment after delivery, infection and eclampsia management, and discharge counseling when the SCC was used. In contrast, several essential practices, including infection and eclampsia management, delivery preparedness, breastfeeding support, and family planning counseling, showed suboptimal adherence (<70%). Healthcare providers working in hospital settings and those who had received prior training were more likely to use the SCC (p < 0.05). The predominant perceived barriers to SCC utilization included time constraints, heavy workload, staff shortages, and inadequate supervision and training. Our study showed suboptimal awareness and a moderate level of adherence to recommended child birth practices. Strengthening knowledge of obstetric healthcare workers is essential to ensure consistent and effective utilization of the WHO SCC, and addressing organizational and system-level challenges may therefore be essential for improving its adherence.
Integrated treatment services for co-occurring mental health and substance use disorders are recommended best practice, yet their relationship with facility-level provision of detoxification and medications for opioid use disorder (MOUDs) is not well understood. The researchers analyzed 2021-2023 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from 49,623 facilities offering any substance use services. Multivariable logistic regression models examined associations between integrated services and availability of detoxification and MOUD, adjusting for facility characteristics and Chronic Care Model elements. Primary treatment focus (substance use, mental health, mixed) was evaluated as an effect modifier. Overall, 61.2% of facilities offered integrated services, 21.2% provided detoxification, and 56.0% provided MOUD. Among substance use-focused facilities, integrated services were associated with higher odds of offering detox (adjusted odds ratio [aOR] = 1.27, 95% CI 1.17-1.37) and MOUD (aOR = 1.44, 95% CI 1.34-1.56). Among mixed-focus facilities, integrated services were associated with higher odds of MOUD (aOR = 1.39, 95% CI 1.28-1.51) but not detoxification. Among mental health-focused facilities, integrated services were associated with lower odds of detoxification (aOR = 0.34, 95% CI 0.22-0.53) and did not predict MOUD availability. Facility type, ownership, and Chronic Care Model elements, including delivery system redesign, self-management support, and clinical information systems, were strong independent predictors of both outcomes. Integrated services may be associated with greater access to detoxification and MOUD in substance use-focused settings but appear insufficient within mental health-focused facilities; efforts to strengthen integrated care should account for facility focus and infrastructure capacity.
Gastrointestinal helminth (GIH) infections remain a significant but undercharacterized threat to captive wildlife health and may contribute to zoonotic transmission at the human-animal interface, particularly in Bangladesh, where zoological facilities are located near densely populated urban centers. This study investigated the prevalence, diversity, and host distribution of GIHs among captive wild animals in two major facilities-the Bangladesh National Zoo and Tilagarh Eco Park, Sylhet-between May and December 2023. In a cross-sectional design, 80 fecal samples from mammals, birds, and reptiles were analyzed using a modified formalin-ether sedimentation technique, and parasites were identified based on morphological criteria. Overall, 51.25% (41/80) of animals were infected with at least one helminth species. Five helminth taxa were detected, including members of Ascarididae and Capillarinae with known zoonotic relevance. Infection prevalence varied by host group, with the highest burden observed in reptiles (100%), followed by herbivorous mammals, whereas carnivorous and omnivorous mammals had lower prevalence (16.67%). Mixed infections occurred in 27.78% of infected animals. The low occurrence of trematodes and cestodes likely reflects the limited availability of intermediate hosts under captive conditions. Despite the absence of overt clinical signs, the high prevalence suggests substantial subclinical infection that may compromise animal welfare and increase zoonotic risk. These findings highlight critical gaps in parasitological surveillance and management in captive wildlife systems and underscore the need for integrated One Health approaches, including routine monitoring, improved husbandry, and targeted parasite control strategies to mitigate infection risks at the human-animal interface.
Internally displaced persons (IDPs) are individuals or groups forced to leave their homes due to conflict, violence, or other coercive circumstances. This study examined the effects of armed conflict on health service availability and outcomes for IDPs residing in designated centers in Adigrat City, Tigray region, Ethiopia. From a total of 13,315 households (HHs), a stratified random sample of 373 respondents was drawn across four zones of Tigray. Key informants were selected using purposive and simple random sampling. Data were collected through direct observation, structured questionnaires, and interviews with key informants. The study focused on key indicators of health service disruption, including destruction of health facilities, access to health extension services, and treatment for chronic diseases, as well as broader health outcomes such as maternal, infant, and elderly mortality. Findings revealed severe negative consequences of war, including widespread destruction and collapse of hospitals and health centers. Regression analysis indicated that approximately 69.8% of the disruption in health service delivery and infrastructure within IDP areas was associated with the combined effects of disrupted banking services and increased crime rates resulting from the conflict. Overall, the study underscores the urgent need for coordinated postwar reconstruction, restoration of critical systems, and targeted interventions to rebuild the health sector and improve the well-being of displaced populations in Tigray.
Men are not only heads and decision-makers in most families, but they also heavily influence the healthcare access of their female partners and/or children. However, low male spousal accompaniment at health facilities remains a persistent public health challenge in rural Tanzania. While structural barriers are well documented, there is a lack of evidence regarding the behavioral intention factors that drive this men's physical disengagement from clinical spaces. Understanding these internal drivers is critical for designing effective targeted interventions to improve maternal service utilization in rural settings. Applying the Theory of Planned Behavior (TPB), this study assessed the predictors of male partners' behavioral intentions and cognitive readiness toward spousal accompaniment in maternal health service utilization in rural Tanzania. A baseline community-based assessment from a longitudinal interventional study was adopted to evaluate 546 randomly selected male partners from June to October 2017 was conducted using a quantitative research approach. A multi-stage sampling technique was employed to select participants. While male accompaniment broadly encompasses emotional and domestic support, this study specifically operationalized male spousal accompaniment as men's physical accompaniment of their expectant mothers to the health facility for clinical maternal health services. Data were analyzed using IBM SPSS version 25. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors (α = 0.05). Participants' mean age was 31 ± 7.726 years, and 71.8% were married. Findings revealed that 61.7% of male partners had never physically accompanied their spouses to health facilities for maternal services. High rates of negative behavioral constructs were observed, with 59.0%, 57.0%, and 57.0% of male partners reporting negative attitudes, demonstrating negative perceived subjective norms, and negative perceived behavior control, respectively. Multivariable analysis showed that positive attitude (AOR = 3.616; p < 0.05; 95%CI: 1.333, 6.138), positive perceived subjective norms (AOR = 2.374; p < 0.05; 95%CI: 1.669, 5.984), and positive perceived behavioral control (AOR = 1.759; p < 0.05; 95%CI: 1.004, 4.373) were significantly associated with increased prospective intention to accompany partners to care. A significant proportion of male partners in rural Tanzania remain physically disengaged from clinical maternal spaces, driven primarily by negative cognitive constructs and traditional social norms that designate pregnancy care as an exclusively female domain. Policy and programmatic actions should prioritize community-based social and behavior change communications (SBCC) that challenge restrictive subjective norms, foster joint family decision-making, and reshape male attitudes toward spousal accompaniment.
Fibromyalgia syndrome (FMS) is a prevalent and disabling chronic pain condition associated with substantial socioeconomic burden and frequent dissatisfaction with conventional care. This supports the need for innovative community-based models. Health Resort facilities deliver multi-component, multidisciplinary programs (e.g., balneotherapy/aquatic exercise, structured exercise, education, and supportive environments) and may represent a promising setting for FMS management. This study aims to systematically evaluate the strategic potential of Health Resorts as an integrated community healthcare model for FMS using a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Factors were identified and synthesized through a targeted narrative search of PubMed and a structured analysis of relevant national and international policy/guidance documents. A strategic analysis was also performed to formulate actionable recommendations by combining internal and external factors. Strengths included the ability to operationalize integrated biopsychosocial, patient-centered care within an immersive environment, and a potentially decentralized access model. Weaknesses included limited validation of standardized integrated protocols, heterogeneity across facilities, and suboptimal integration with public healthcare systems. Evidence for cost-effectiveness remains hypothesized pending dedicated economic evaluations. Health Resorts offer a promising paradigm for FMS management, shifting from fragmented treatment to an integrated, community-based approach. However, realizing this potential requires addressing critical weaknesses, particularly the need for a stronger evidence base, standardization of protocols, and improved integration with national health services.
Despite widespread acknowledgment of physical activity's (PA) benefits, inactivity remains a significant public health challenge, exacerbated by environmental and socioeconomic factors. This study investigates how environmental health burdens-specifically air pollution and smoking-related disease burdens-alongside socioeconomic conditions shape PA patterns across different life stages in OECD countries. Using cross-sectional data from 38 OECD countries, age-stratified beta regression models examined the determinants of PA prevalence among adolescents (ages 11-17), adults (ages 18-69), and older adults (ages 70+). Independent variables included air pollution-related and smoking-related Disability-Adjusted Life Years (DALYs), Body Mass Index (BMI), GDP per capita, urbanization, internet penetration, access to sports facilities, healthcare expenditure, and average annual working hours. Data imputation techniques ensured dataset completeness, supported by auxiliary demographic variables. Robustness checks included multicollinearity assessments, non-linear tests, and sensitivity analyses. Adolescents exhibited relatively high PA rates, positively influenced by urbanization only when socioeconomic contexts were considered (β=0.119, p=0.031). Adult PA was significantly boosted by greater access to sports facilities (β=0.172, p=0.019), while internet penetration negatively impacted activity levels marginally (β=-0.126, p=0.068). For older adults, PA increased notably with better sports facility access (β=0.178, p=0.001) but declined with higher air pollution-related (β=-0.128, p=0.028) and smoking-related DALYs (β=-0.097, p=0.027), as well as increased internet penetration (β=-0.143, p=0.030). Determinants of PA vary markedly across age groups and include significant interactions with environmental and socioeconomic factors. Urbanization enhances adolescent PA contingent on supportive environments. In adults and older adults, infrastructure such as sports facilities proves essential, though environmental health burdens significantly limit activity in older populations. Age-specific, environmentally informed public health strategies and infrastructural interventions are critical to sustainably promoting PA across life stages.
Routine surveillance through the health management information system (HMIS), has taken a de facto management structure centered on district leadership, aided by the district health information software for reporting. System performance and credibility has long been derived on the basis of data indicators with little to no consideration of dimensions on human-resources in charge. This study therefore aimed to assess attitudes and practices of HMIS managers at district-level. A cross-sectional study was conducted across all 15 malaria endemicity regions of Uganda between January and June 2024. Semi-structured interviews were conducted among HMIS managers in at least one district-level health office per region. The primary outcomes of the study included attitude and practices in malaria routine reporting, particularly data recording, review, reporting, analysis, and use, as well as support supervision. Results were summarized using descriptive statistics and word clouds. The 34 participants from 30 districts and cities included biostatisticians (70.6%) and HMIS focal persons (23.5%), overseeing 6 to 1043 actively reporting health facilities. All participants reviewed the reports they received, with 75.8% reporting documenting the mistakes found, though only 31.6% could show their documented queries. By survey date, 81.6% of expected routine reports had been received by the district-level health office, with 25.4% of them received after active follow-up with health facilities. With nearly all data submitted to DHIS-2 by the 15th day of the new month, 93.9% received queries constituting a mean of 4.2 queries per implicated health facility. Whereas ≈70% preferred quarterly DHI support supervision visits, 39.4% had received one to two such visits while 51.5% provided support supervision to their facilities, over the past 12 months. Generating mostly summary tables, trend and endemic channel plots, key data uses included performance reviews, resource (re)allocation, as well as staffing needs' assessments. Highly capable human resource teams at district-level health offices administered HMIS routine reporting. Teamwork with health facility officials provides a framework for HMIS strengthening. Gaps remain in: use of or adherence to standard operating procedures for data reporting, feedback, and follow-up; conducting scheduled and/or evidence-driven support supervision; and, confidence in and advanced analytical skills facilitating improved data use.
Primary health care (PHC) systems are typically organized using uniform administrative models that assume functional similarity across facilities. In practice, however, PHC units differ substantially in how services are delivered. In Greece, despite ongoing reforms, empirical evidence on the functional heterogeneity of public PHC units remains limited. This study aims to classify PHC units based on observed service utilization patterns and to identify the organizational and geographical determinants shaping these functional typologies. This cross-sectional study analyzed administrative data from 649 public PHC units in Greece (2024). Visit compositions (regular, emergency, prescription, and other) were analyzed using compositional data analysis with centered log-ratio transformation. K-means clustering was applied to identify utilization-based functional typologies. Associations between cluster membership and unit characteristics (size, organizational type, and geography) were examined using ANOVA and chi-square tests. Three distinct functional typologies emerged. Cluster 1 ("balanced, generalist units", n = 308) exhibited a mixed service profile across visit types. Cluster 2 ("routine care-focused units", n = 66) was dominated by regular visits (82.4%) and minimal prescription activity, but showed substantial within-cluster variability in emergency care. Cluster 3 ("mixed, higher-intensity units", n = 275) displayed a heterogeneous case-mix and a greater share of complex or administrative activity. Cluster membership was significantly associated with unit size, organizational type, and geographical location (p < 0.001). Cluster 1 units were significantly larger, followed by Cluster 3, while Cluster 2 units were the smallest. Organizationally, Cluster 1 was dominated by Rural Health Centers and Local Health Units, Cluster 2 by Local Medical Practices and Urban Health Centers, and Cluster 3 by Multipurpose Regional Medical Practices and Local Health Units. Spatially, higher-intensity units (Cluster 3) were predominantly located in major urban centers. PHC is functionally heterogeneous, with distinct utilization profiles that are not captured by existing administrative classifications. These findings reveal a structural misalignment between formal organizational labels and actual service delivery. A utilization-based typology provides a practical tool for health policy and management, supporting more targeted approaches to resource allocation, workforce planning, and regional service design. Incorporating functional differentiation into PHC governance can enhance efficiency, equity, and system responsiveness.
Background and objectives Diagnosis and treatment of infertility, mostly sought at tertiary facilities, contribute to substantial out-of-pocket expenditure (OOPE). This study estimated OOPE among couples seeking care for endometriosis, male infertility, polycystic ovary syndrome (PCOS), tubal factor, and uterine factor, including costs of diagnosis, management, and intrauterine insemination (IUI). Methods A cross-sectional study was conducted across five tertiary healthcare facilities (three public, two private) selected through convenience sampling to represent different regions. Based on mean (SD) OOPE INR (₹)144,393 (₹130,943), effect size 0.16, α=0.05, and 80% power, the sample was equally distributed across sites and IVF/non-IVF groups, with ∼100 participants per site. Couples were interviewed between April 2022-March 2023. Catastrophic health expenditure was defined as infertility spending exceeding 40% of annual household non-food expenditure. OOPE over the preceding year covered direct medical, non-medical, and indirect costs. Results Annual median OOPE was ₹11,317 (US $136.5) (IQR: ₹4,801-₹19,513) US $, higher in private facilities ₹14,217 ($171.4) (IQR: ₹8,030-₹21,848) than public facilities ₹8,355 ($100.7) (IQR: ₹3,785-₹17,386). Direct medical costs were the major contributor: median ₹5,802 ($69.9) (IQR: ₹2,186-₹11,847) Highest OOPE was for endometriosis ₹15,084 ($181.9) (IQR: ₹8,114-₹20,758), followed by uterine factor and male infertility ₹13,211 ($159.3) (IQR: ₹6,654-₹21,521). OOPE increased with absence of insurance (₹6,919; $83.4), comorbidities (₹2,593; $31.3), IUI (₹2,668; $32.1), and PCOS (₹2,004; $24.1). Catastrophic Health Expenditure was associated with comorbidities (OR=1.61), IUI (OR=1.88), and lower per capita income <₹59,400 ($715.7) (OR=3.44). Overall, 59.4% experienced CHE. Interpretation and conclusions Infertility care imposes substantial out of pocket expenditure in India. Strengthened insurance coverage and public sector investment are critical for equitable access.
 Prevention of Mother-to-Child Transmission (PMTCT) guidelines provide evidence-based protocols to prevent infections such as human immunodeficiency virus (HIV) from passing from mother-to-child. Regular updates ensure alignment with evolving treatments and best practices. It is therefore essential that all healthcare professionals clearly understand and consistently follow the latest PMTCT guidelines. So far, there seems to be limited research that explored healthcare professionals' knowledge and practices regarding the PMTCT guidelines in South Africa.  This study aimed to assess healthcare professionals' knowledge and compliance related to the South African 2023 PMTCT guidelines.  Healthcare professionals involved in antenatal and postnatal care across public and private healthcare facilities in all South Africa's provinces.  A cross-sectional study of 221 participants (35 doctors, 77 nurses and 109 clinical associates) was conducted over 8 weeks using an online survey distributed via social media.  Participants generally demonstrated high knowledge of the PMTCT guidelines, with significantly higher scores among those who had received formal training. Some knowledge deficits, e.g. in HIV testing procedures and infant antiretroviral dosing, remain. Doctors showed significantly higher knowledge scores than nurses and clinical associates. Fewer than half of the participants reported consistent compliance.  While knowledge of the PMTCT framework was high, low compliance remains.Contribution: This study provides foundational information on the knowledge of healthcare professionals across various South African provinces about the 2023 PMTCT guidelines, highlights the vital role of clinical associates and stresses the need for consistent and structured PMTCT training.
Irrational drug use poses a persistent challenge to healthcare quality and economic efficiency. In the context of China's "Tight-knit Urban Medical Group" reform, this study analyzes a digitized pharmaceutical governance model designed to bridge the gap in pharmaceutical care between tertiary hospitals and primary healthcare facilities. We aimed to analyze the implementation and public health correlation of a Centralized E-prescription Review (CEPR) platform within a regional medical network. A retrospective, observational real-world study was conducted in Sanya, China. We implemented a CEPR platform utilizing a dual-layered cloud architecture and non-invasive data acquisition (XTL) to integrate regional drug metadata. The system incorporates an AI-driven engine fusing Large Language Models (LLMs) with Retrieval-Augmented Generation (RAG) to provide clinical decision support. A total of 441,327 prescriptions were analyzed over a 12-month longitudinal period. The Cochran-Armitage trend test was employed to evaluate temporal shifts in prescription safety, economic efficiency, and service homogeneity. Following the implementation of the CEPR platform, the initial prescription pass rate at primary healthcare institutions rose significantly from 75.00 to 95.12%, and a 99.30% pharmacist intervention success rate was achieved across more than 16,000 intercepted high-risk orders. Regarding economic efficiency, the average cost per outpatient visit decreased by 4.58%, while inpatient drug costs dropped by 23.5%, accompanied by the implementation of a technology-based integrity oversight mechanism. Notably, the regional irrational prescription rate over 12 consecutive months of operation decreased markedly from 11.92 to 7.35% (χ2  = 328.42, p < 0.001), demonstrating a robust temporal association between platform deployment and quality improvement. The CEPR model, characterized by the "Sanya Model," serves as a digital lever for enhancing the accessibility and homogeneity of high-quality pharmaceutical services. By shifting medication safety from a site-specific resource to a standardized public service, this framework supports the "Three medical linkage" (San Yi Lian Dong, i.e., the integrated reform of medical services, health insurance, and pharmaceutical systems) collaborative reform. These findings provide a scalable governance paradigm for improving public health resilience in regions with unevenly distributed medical resources.
Syndromic management remains the primary approach for identifying and treating sexually transmitted infections (STIs) in low-resource settings. While faster and inexpensive, it leads to overtreatment, undertreatment and missed opportunities for surveillance. Recent advances in point-of-care (POC) diagnostic technologies for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other STIs present new opportunities to improve STI management. In September 2024, the Gates Foundation convened a 3-day expert meeting in Nairobi, Kenya, bringing together 44 global and national experts in STI diagnostic development, implementation research, policy, regulatory affairs and clinical practice. The objective was to identify priorities and strategies for advancing the introduction and scale-up of STI POC testing in low-resource settings with a focus on sub-Saharan Africa. Participants identified opportunities and barriers for introducing STI POC testing at various levels: individual client, health service delivery, national and global. At the individual client level, recommendations to optimise testing uptake included identifying and piloting strategies to improve knowledge about STIs and testing as well as addressing barriers to testing. At the health service delivery level, recommendations were to optimise clinical workflows, consider testing outside traditional health facilities (including private pharmacies), encourage self-collection and improve partner notification. At the national level, recommendations included updating treatment guidelines to incorporate diagnostic testing, strengthening laboratory quality assurance for STI tests and advocating for the public health importance of STIs, which remain underprioritised. This also involves building political commitment. At the global level, recommendations included harmonising regulatory requirements across regions, leveraging WHO prequalification processes, and expanding manufacturing capacity through technology transfer. Effective introduction of STI POC diagnostics in low-resource settings will require coordinated efforts across global and national levels. Successful introduction, while ensuring equitable access, will accelerate access to quality STI care, reduce antimicrobial resistance and improve STI control outcomes.