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Current Issue
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Helping Public Health Decision-Makers Refine Community Coronavirus Disease-2019 Vaccination Efforts–Association between Confirmed Coronavirus Disease-2019 Cases and Vaccinations
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Introduction
The response to the coronavirus disease-2019 (COVID-19) epidemic included biomedical and vaccine research as well as identification of COVID-19 cases, contact tracing, community health promotion and disease prevention and community vaccination. The COVID-19 vaccinations remind public health professionals and non-professionals alike of this essential public health intervention for controlling infectious diseases. Actions that seek to improve existing vaccination efforts are equally important for effective public health programming.
Methods
Secondary data analysis uses an ecological study design to examine any possible associations between the number of COVID-19 cases identified at medical facilities (facility names not identified) within a healthcare system and the number of COVID-19 vaccinations administered within the system and reflect upon the findings for public health action. A loess curve was plotted to help to identify if a curvature pattern was present in a scatter plot.
Results
The statistical algorithm for the loess curve identified a curvature pattern. All plots showed that values became more separated in moving from left to right.
Discussion
This aggregate pattern in number of COVID-19 cases and number of vaccinations administered might be present in other public health settings or healthcare systems. Four refinements were proposed to help public health decision-makers to improve vaccination efforts: explore the reasons for differences in COVID vaccination given the number of confirmed COVID cases between
facilities; provide vaccination outside traditional settings; facilitate public health and primary care partnerships for community vaccination; and address vaccine knowledge-gaps in the community and other barriers to vaccination.
Keywords
COVID-19 vaccination; Refining vaccination efforts; Public health decision-makers; Public health and primary care partnerships; Ecological study; Loess curve.
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A Study on the Role of Public Health in Reducing the Abuse of Ambulance Services
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Background
Demand for emergency medical services or ambulance response is situated within the context of other healthcare and social welfare services. Worldwide ambulance providers have a wide variety of services available, but many services are struggling to meet service demand. Inappropriate use of ambulance services is one of the biggest concerns globally. The burden of using the ambulance services includes transporting non-critical patients to the hospital. Misuse of the ambulance services is a serious problem that must be addressed and solved.
Objective
The purpose of this study is to evaluate the public perception of appropriate usage of ambulance services and determine the applicable role of public health to reduce the inappropriate use of an ambulance.
Methodology
A cross-sectional study was conducted to collect data from the general public using an online survey. The survey contains 9 questions that evaluate the public awareness of appropriate ambulance use. Participants are people from the public within the age of 18 and above.
Sample Size
A total of N=97 of participants’ responses were used to analyze the data.
Inclusion Criteria
Complete surveys and answer data using the English language.
Exclusion Criteria
Uncompleted surveys, and answered with other languages.
Results
During the online survey, a total of n=97 participants enrolled voluntarily. The majority of the residents are aware of when to and whom to call in case of a medical emergency. N=35 (36%) of the participants believe that ambulance services are misused.
Conclusion
The conducted study demonstrated that almost 36% of participants believed abuse of ambulance services, though there might be numerous reasons for calling ambulance unnecessary. Public health plays a vital role to reduce inappropriate ambulance calls when both ambulance services and public health are integrated into one system of care.
Keywords
Public health; Ambulance services; Emergency medical services (EMS); Emergency care pathway; Misuse of ambulance services; Paramedic; Scope of public health in EMS.
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Assessing the Private Sector and Civil Society Engagement in Poliomyelitis Myelitis Vaccination among Internally Displaced People in Khartoum State, 2019
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Background
Poliomyelitis is an oro-fecal vaccine preventable disease affecting mainly children under five-years-old and is prevalent in poor sanitation and hygiene environment. The World Health Organization (WHO) stressed the need for coordination between the public and the non-governmental (particularly private) sectors to increase the coverage with immunization. This study aims to assess the private sector and civil society engagement in the implementation of poliomyelitis vaccination among internally displaced people and irregular settlement in Khartoum. Specifically, the study aimed to identify the major gaps in immunization program among internally displaced people (IDP), and to determine the enablers and barriers for the private sector and civil society active engagement in the immunization program.
Methods
This cross-sectional study used both quantitative and qualitative methods. Data was collected from the health facilities mangers and the expanded program of immunization (EPI) service providers at private and civil society’s facilities in the targeted areas using a semi-structured interview guideline and a self-administered questionnaire respectively. The obtained quantitative data was coded and then analyzed using the statistical package for social science (SPSS version 21) and presented using tables. For qualitative part, all data were transcribed verbatim and analyzed using a thematic analysis, paying particular attention to axes of difference, including gender, private center and non-governmental organization.
Results
The major gaps were the insufficient number of health facilities together with uneven distribution of the available ones, and unclear mandate of non-governmental organizations (NGOs) and private sector in EPI programme. Most of the managers complained from the lack of human resources for vaccination but stressed on the fact that training of the existing staff made the availability of the service easier. Twelve (12) out of 23 health facilities visited by the field team where in areas that do not have electricity or water supply which imposed more efforts to preserve the vaccines.
Conclusion
Private and civil societies were not well utilized by EPI program in Khartoum, Sudan. A clear mandate for engagement and periodic training for the service providers is highly needed.
Keywords
Private sector; Civil societies; Poliomyelitis vaccination; Internally displaced people (IDP).
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Developing a Probit Regression Model for Estimating the Chance of Mortality for Coronavirus Disease-2019 Patients
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Rational
Although the number of deaths of coronavirus disease-2019 (COVID-19) is decreasing over the world due to vaccination process, but appearing its new variants remain it as the remarkable challenge for health authorities.
Purpose
The aim of this study is to develop a probit regression model to estimate the chance of mortality for the patients infected to COVID-19.
Methodology
The contributing factors of age, symptoms and underlying diseases have been considered as independent variables as well as the clearance type of death as dependent variable have been studied for estimating the mortality rate. Patients have been divided into two categories; 1) recovered or transferred and 2) death, followed by developing a probit regression model by the well-known technique of Max likelihood method.
Data Collection
Data have been collected for 1015 patients tested positively to COVID-19 and subsequently received clinical treatment or intensive care.
Conclusion
The results revealed the model is capable of estimating the chance of mortality based on age, symptoms and underlying diseases. As implication, the health authorities ultumately can estimate the patient mortality rate prior to admission procedures in hospitals.
Keywords
COVID-19; Mortality rate; Healthcare management; Probit regression; Maximum likelihood.
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A Physicians Commentary on Electronic Health Records in the United States Medical Practice
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Towards Universal Health Coverage: Designing a Community Based Intervention to Scale Up Coverage with Health Insurance, in A-Duiem Administrative Unit, Sudan 2018-2019
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Prevalence and Risk Factors of Low High-Density Lipoproteins-Cholesterol: An Analysis of the United States of America National Health and Nutrition Examination Survey, 2015-2016
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Hypertension Management in Primary Health Care Centres: Blood Pressure Control and Classes of Antihypertensive Medication, Khartoum State, 2018
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Previous Issue
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Barriers to Community Integration for Older People in Malaysia: A Qualitative Study from Occupational Therapist Perspectives
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Introduction
Existing research has addressed the importance of community integration (CI) and its benefits of dwelling in a community but has yet to address the methods and efficiency of improving these activities among older people. Thus, it is vital to understand how healthcare workers can integrate the benefits of CI among older people, especially with the use of occupational therapists (OTs). The latter are actively working to improve ageing individuals mobility within the community.
Objective
This study aims to identify Malaysian OTs’ perspectives on CI’s and its implication on older people.
Method
Occupational therapist from different states of Malaysia participated in a semi-structured interview, through a virtual medium (Zoom Cloud Meetings). The interview guide encapsulated the theory of critical incident technique (CIT).
Results
Thematic content analysis, over fourteen participants from 13 states of Malaysia, provided insights into CI’s barriers for older people in Malaysia. The findings revealed that multifaceted factors from an individual, organisational and socio-environmental perspective limit older people’s active CI engagement.
Conclusion
South-East Asia hierarchal and collectivist culture play a significant role in influencing all factors of CI. OTs must understand and incorporate appropriate cultural norms during CI practice development for the older population in Malaysia.
Keywords
Occupational therapist; Critical incident technique; Older people; Community integration; Qualitative study; Societal norms; Cultural norms.
A Physicians Commentary on Electronic Health Records in the United States Medical Practice
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This commentary presents a point of view on how the arrival of electronic health records (EHR) in the United States (U.S.) has changed physicians’ practice. EHR implementation has pros and cons. EHR systems have been a great asset during the
pandemic and help with efficiency, safety, and cost reduction. Despite their benefits, healthcare providers and organizations still face challenges, including usability and interoperability across systems, contributing to physicians’ burnout. Can physicians adopt new technologies and adapt to current challenges? Is it the right time for physicians to stop being observers and become active
participants in the process of healthcare innovation and implementation?
Keywords
Physician; EHR; Implementation; Physicians’ burnout.
Towards Universal Health Coverage: Designing a Community Based Intervention to Scale Up Coverage with Health Insurance, in A-Duiem Administrative Unit, Sudan 2018-2019
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Background: Community engagement has proved effective in increasing access to healthcare including health insurance, in developed and developing countries.
Aim: The study aims at designing and testing the effectiveness of engaging the community in awareness-raising and increment of health insurance coverage.
Methods: The study was a social interventional community-based study, conducted in A-Duiem Administrative Unit, A-Duiem Locality, Sudan. Baseline data on enrollment in health insurance was collected from 800 heads of households, whereas data on knowledge and attitudes about health insurance was collected from 420 heads of non-insured households using a standardized questionnaire. Strategies to scaleup health insurance through community engagement was collected from community leaders, local authorities, and health insurance policymakers through in-depth interviews and focus group discussions. The community promotion package of health insurance was implemented for one year and post-intervention data were collected from 420 heads of households. Quantitative data were analyzed using SPSS version 20. Statistical significance was set at p<0.05 when the confidence interval was 95%. Qualitative data was analyzed manually using the thematic approach.
Results: The study showed significant improvement in the knowledge of the heads of the non-insured households about health insurance after the intervention; knowledge about the enrollment process and service’s package has increased from 34.4% to 61.8% and from 55.8% to 84.7% respectively (p-value 0.0001 in both). The health insurance coverage increased by 17.3% with a significant difference and p-value at 0.0001.
Conclusion: The study concluded that community members have a considerable role in awareness-raising and scaling up of health insurance coverage if they are properly organized, trained, monitored, and supervised. The insufficient commitment of local officials in the unit was a challenge to address during further testing and expansion of the experience.
Keywords
Health insurance; Population coverage; Knowledge; Attitudes; Community engagement; Intervention; Sudan.
Prevalence and Risk Factors of Low High-Density Lipoproteins-Cholesterol: An Analysis of the United States of America National Health and Nutrition Examination Survey, 2015-2016
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Background
Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, with cardiovascular diseases (CVDs) being the most predominant. This is a similar trend in the United States (U.S.). Modifiable and non-modifiable factors are important determinants of dyslipidaemia, a known cause of CVDs.
Objective
This study aimed to explore the pattern of high-density lipoprotein cholesterol (HDL-C) distribution and its associated risk factors.
Methods
The data was collected from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 database which is part of the yearly cross-sectional survey. The NHANES uses complex multistage probability sampling method in data collection. The target population was the noninstitutionalized civilian living across the U.S. The primary sampling units were individuals. Socio-demographic characteristics, body measurement (waist circumference) and blood samples (to determine HDL-C and total cholesterol levels) were recorded. In the database, 5000 respondents were randomly selected for analysis. Statistical analyses were performed using Stata version 14.0. The results are described as means and standard deviation (SD) for group and continuous variables. Regression analyses were used to identify risk factors of low HDL-C.
Results
Of the complete cases (3989), 49.03% were males. The mean age was 46.57±15.44-years. The mean HDL-C was 1.39±0.45 mmoL/L. The prevalence of low HDL-C was 32.8% in males and 12.5% in females. The results obtained from multiple linear regression indicated that male gender, age, ethnicity, country of birth, number of children aged 0-18-years per household, waist circumference, family income to poverty ratio and total cholesterol were significantly associated with HDL-C. Multivariable logistic regression revealed male gender, age 30 to 49-years, ethnicity, smoking, enlarged waist circumference (cm), low family income to poverty ratio and high total cholesterol were associated with low HDL-C.
Conclusion
The prevalence of low HDL-C of was 22.4 %. This was distributed into 32.8% in males and 12.5% in females. The associated risk factors show that lifestyle modification is important in the prevention of low HDL-C and consequently, CVDs.
Keywords
HDL-C; Risk factors; Cardiovascular diseases; NHANES.
Hypertension Management in Primary Health Care Centres: Blood Pressure Control and Classes of Antihypertensive Medication, Khartoum State, 2018
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Background
In Sudan, the delivery of care based on the primary health care (PHC) level, which is the first contact with the health system. PHC is the level at which the modifiable risk factors for hypertension are addressed together with the treatment of known hypertensive patients.
Objective
To assess the management of hypertension in PHC in Khartoum State, 2018.
Material and Methods
The study was a descriptive cross-section, health centre’s based that covered six PHC centres in Khartoum State. The study interviewed all diagnosed Sudanese hypertensive patients more than 18-years of age who attended the selected PHC centres. The research team collected data using a structured questionnaire and measuring the blood pressure (BP) with a mercury sphygmomanometer. The study variables were demographic characteristics and disease features as independent variables and hypertension control as the dependent variable. The statistician analyzed the data using the statistical package for the Social Science version 21.0 and the Chi-square (χ) test to obtain the p value to test the association between the addressed variables. The study group adopt ethical considerations throughout the study.
Results
Of the 384 hypertensive patients interviewed in this study, 57% were females and 47.7% were more than 60-years of age. A large percent of the subjects were either primary educated or illiterate (32.6%, 19.8% respectively). More than half of the hypertensive patients (52.1%) were uncontrolled and 52.9% had no comorbidities. Diabetes was predominant (39.3%) among those who had comorbidities. The majority of the patients (92.7%) were adherent to the medication. Of the studied patients, 58.1% used monotherapy. The most controlled patients were the elderly and middle-aged patients and the highly educated patients (p=0.005). Patients with a duration less than five-years were more likely to be controlled (p=0.036). The majority of the patients who used combined treatment were found to be controlled.
Conclusion
This study concluded that the high prevalence of uncontrolled hypertensive patients attending PHC was mainly attributed to the use of monotherapy, presence of comorbidities and medication non-adherence. The latter is related to patients’ ignorance, financial constraints and dislike of using many drugs during the day. In addition, elder age and high education were factors for
better control.
Keywords
Hypertension control; Antihypertensive medication; Hypertension management.
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