Tag: statistics

S Afr Fam Pract (2004). 2024 May 14;66(1):e1-e9. doi: 10.4102/safp.v66i1.5943.

ABSTRACT

BACKGROUND: Despite the efforts of Namibia’s Ministry of Health and Social Services to build maternity waiting homes (MWHs), few pregnant women make use of them. Long distances among the general population in Namibia limit the utilisation of MWHs. Little research has investigated what factors are limiting the use of these facilities despite the urgent need for them. The aim of this study thus was to explore and describe the perspectives of pregnant women on the utilisation of the MWHs near Onandjokwe Lutheran Hospital in Oshikoto Region.

METHODS: A qualitative, exploratory, descriptive and contextual design was employed. The accessible population in this study comprised 18 participants who were selected for the study using a purposive sampling technique.

RESULTS: Participants reported numerous barriers to visiting MWHs in Namibia, including an inadequate number of rooms, theft, food scarcity and the effects of poverty on the living conditions of the MWH users. Enablers visiting MWHs included the safe delivery of babies by skilled staff, reduced transport costs, access to timely management of labour complications and affordable accommodation.

CONCLUSION: The study revealed that a number of barriers must be overcome before the desired number of women take advantage of MWHs. Multiple factors act as constraints to their use, including inadequate number of rooms, theft, food scarcity and the long distance between patients’ homes and MWH services.Contribution: The study’s findings can be used to develop targeted interventions and strategies that can be used by MWH providers to address the identified barriers.

PMID:38832389 | DOI:10.4102/safp.v66i1.5943

S Afr Fam Pract (2004). 2024 May 10;66(1):e1-e8. doi: 10.4102/safp.v66i1.5837.

ABSTRACT

BACKGROUND: In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape.

METHODS: A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences.

RESULTS: Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% – 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%).

CONCLUSION: The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.

PMID:38832386 | DOI:10.4102/safp.v66i1.5837

Afr J Prim Health Care Fam Med. 2024 May 9;16(1):e1-e11. doi: 10.4102/phcfm.v16i1.4421.

ABSTRACT

BACKGROUND: South Africa’s health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers.

AIM: This study mapped Clin-As’ history and practice in South Africa, assessing their roles in the health workforce and offering recommendations.

METHODS: Following the framework outlined by Arksey and O’Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening.

RESULTS: Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As’ perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation.

CONCLUSION: As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa’s health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution: This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

PMID:38832380 | DOI:10.4102/phcfm.v16i1.4421

Afr J Prim Health Care Fam Med. 2024 May 15;16(1):e1-e9. doi: 10.4102/phcfm.v16i1.4436.

ABSTRACT

BACKGROUND: Burnout in doctors is an important issue with far-reaching consequences. Community service doctors may be particularly vulnerable because of their specific roles (rural settings, junior positions and reduced supervision).

AIM: This study aimed to determine the prevalence of burnout among community service doctors in South Africa (SA), the potential contributory and protective factors and the consequences thereof.

SETTING: This was a national study of community service doctors in SA.

METHODS: A quantitative, descriptive cross-sectional study was performed. The Maslach Burnout Inventory was used to measure burnout. The online questionnaire also included demographic data, workplace and individual characteristics.

RESULTS: Of the 208 community service doctors analysed, 89% and 94% had high emotional exhaustion and depersonalisation, respectively, while 97% had a low personal accomplishment. Mental illness, financial difficulties, unmanageable volume of patients and female gender were found to be potential contributory factors. Having manageable patient volumes, satisfaction with their decision to study medicine, talking to colleagues and feeling supported by healthcare facility management were among the significant potential protective factors. Significant potential consequences of burnout included: leaving the government sector, ever being diagnosed with a mental illness, using alcohol as a coping mechanism and possible current major depression.

CONCLUSION: Burnout among community service doctors in SA is highly prevalent with significant potential consequences. There are a number of modifiable possible contributory and protective factors identified that may be targets for mental health interventions.Contribution: Healthcare burnout research is lacking in the African and specifically SA context. This void includes community service doctors.

PMID:38832374 | DOI:10.4102/phcfm.v16i1.4436

J Neurosci. 2024 Jun 3:e1344232023. doi: 10.1523/JNEUROSCI.1344-23.2023. Online ahead of print.

ABSTRACT

It was proposed that a reorganization of the relationships between cognitive functions occurs in dementia, a vision that surpasses the idea of a mere decline of specific domains. The complexity of cognitive structure, as assessed by neuropsychological tests, can be captured by Exploratory Graph Analysis (EGA).EGA was applied to the neuropsychological assessment of people (humans) with Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD) (Total N=638). Both sexes were included.In AD, memory scores detach from the other cognitive functions and memory subdomains reduce their reciprocal relation. SCD showed a pattern of segregated neuropsychological domains, and MCI showed a noisy and less stable pattern.Results suggest that AD drives a reorganization of cognitive functions toward a less fractionated architecture compared to preclinical conditions. Cognitive functions show a reorganization that goes beyond the performance decline. Results also have clinical implications in test interpretations and usage.Significance Statement The manuscript proposes an innovative vision for the study of the complex reorganization of cognition in people with dementia.We applied a sophisticated, reliable, cutting-edge statistical method (i.e., Exploratory Graph Analysis – EGA) to the neuropsychological evaluations of 638 patients classified into Subjective Cognitive Decline (N=155), Mild Cognitive Impairment (N=242) and Alzheimer’s Disease (N=241).Patients with Alzheimer’s Disease showed a simplified architecture as compared to subjects with Subjective Cognitive Decline. The MCI group resulted in sharing specific aspects with the SCD and others with the AD.Recognizing the complexity of the cognitive organization is fundamental for properly understanding cognitive impairment and stimulate the discussion about the interpretation of neuropsychological profiles from a more systemic point of view.

PMID:38830757 | DOI:10.1523/JNEUROSCI.1344-23.2023

BMJ Open. 2024 Jun 3;14(6):e085743. doi: 10.1136/bmjopen-2024-085743.

ABSTRACT

OBJECTIVE: To assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.

DESIGN: A prescription-based, cross-sectional study.

SETTING: Six community chain pharmacies in Asmara, Eritrea.

PARTICIPANTS: All outpatient prescriptions dispensed to the elderly population (aged 65 and above) in the six community chain pharmacies in Asmara, Eritrea.

DATA COLLECTION AND ANALYSIS: Data were collected retrospectively, between 16 June 2023 and 16 July 2023. Antibiotic prescribing practice was assessed using the 2023 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification system. Descriptive statistics and logistic regression were performed using IBM SPSS (V.26.0). P values less than 0.05 were considered as significant.

RESULTS: Of the 2680 outpatient prescriptions dispensed to elderly population, 35.8% (95% CI: 34.0, 37.6) contained at least one antibiotic. Moreover, a total of 1061 antibiotics were prescribed to the elderly population. The most commonly prescribed antibiotics were ciprofloxacin (n=322, 30.3%) and amoxicillin/clavulanic acid (n=145, 13.7%). The Access category accounted for the majority of antibiotics (53.7%) with 32.1% from the Watch category. Prescriber qualification (Adjusted Odds Ratio (AOR)= 0.60, 95% CI: 0.44, 0.81) and polypharmacy (AOR= 2.32, 95% CI: 1.26, 4.27) were significant determinants of antibiotic prescribing in the elderly population. Besides, sex (AOR=0.74, 95% CI: 0.56, 0.98), prescriber qualification (AOR=0.49, 95% CI: 0.30 to0.81) and level of health facility (AOR 0.52, 95% CI 0.34 to 0.81) were significant determinants of a Watch antibiotic prescription.

CONCLUSION: Antibiotics were prescribed to a considerable number of the elderly population, with more than half of them falling into the Access category. Further efforts by policy-makers are needed to promote the use of Access antibiotics while reducing the use of Watch antibiotics to mitigate risks associated with antimicrobial resistance.

PMID:38830743 | DOI:10.1136/bmjopen-2024-085743

BMJ Open. 2024 Jun 3;14(6):e079719. doi: 10.1136/bmjopen-2023-079719.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the prevalence of indigenous herbal medicine use and its associated factors among pregnant women attending antenatal care (ANC) at public health facilities in Dire Dawa, Ethiopia.

DESIGN: A facility-based cross-sectional study design.

SETTING: The study was conducted in seven public health facilities (one referral hospital, three urban and three rural health centres) in Dire Dawa, Ethiopia, from October to November 2022.

PARTICIPANTS: 628 pregnant women of any gestational age who had been on ANC follow-up at selected public health facilities were included.

MAIN OUTCOME MEASURES: Prevalence of indigenous herbal medicine (users vs non-users) and associated factors.

RESULTS: The study revealed that 47.8% (95% CI 43.8% to 51.6%) of pregnant women used herbal medicines. Lack of formal education (adjusted OR, AOR 5.47, 95% CI 2.40 to 12.46), primary level (AOR 4.74, 95% CI 2.15 to 10.44), housewives (AOR 4.15, 95% CI 1.83 to 9.37), number of ANC visits (AOR 2.58, 95% CI 1.27 to 5.25), insufficient knowledge (AOR 4.58, 95% CI 3.02 to 6.77) and favourable perception (AOR 2.54, 95% CI 1.71 to 3.77) were factors significantly associated with herbal medicine use. The most commonly used herbs were garden cress (Lepidium sativum) (32%), bitter leaf (Vernonia amygdalina) (25.2%), moringa (Moringa oleifera) (24.5%). Common indications were related to gastrointestinal problems, blood pressure and sugar.

CONCLUSION: The prevalence of herbal medicine use is high (one in two pregnant women) and significantly associated with education level, occupation, ANC visits, knowledge and perceptions. The study’s findings are helpful in advancing comprehension of herbal medicines using status, types and enforcing factors. It is essential that health facilities provide herbal counselling during ANC visits, and health regulatory bodies ought to raise awareness and implement interventions to lower the risks from over-the-counter herbal medicine use by pregnant women.

PMID:38830740 | DOI:10.1136/bmjopen-2023-079719

BMJ Open. 2024 Jun 3;14(6):e082025. doi: 10.1136/bmjopen-2023-082025.

ABSTRACT

OBJECTIVE: The aim of this study is to estimate the indirect economic burden of 22 cancer types in Jordan using both the human capital approach (HCA) and the value of a statistical life year (VSLY) approach. Additionally, this study aims to forecast the burden of these cancers for the next 5 years while employing time series analysis.

DESIGN: Retrospective observational study with a time series analysis.

PARTICIPANTS: Disability adjusted life years records from the IHME Global Burden Disease estimates 2019 data.

PRIMARY OUTCOME MEASURE: Indirect economic burden of cancer in Jordan.

RESULTS: The mean total economic burden for all cancers is estimated to be $1.82 billion using HCA and $3.13 billion using VSLY approach. The cancers contributing most to the total burden are ‘tracheal, bronchus and lung cancer’ ($359.5 million HCA, $618.3 million VSLY), followed by ‘colon and rectum cancer’ ($300.6 million HCA, $517.1 million VSLY) and ‘breast cancer’ ($292.4 million HCA, $502.9 million VSLY). The indirect economic burden ranged from 1.4% to 2.1% of the gross domestic product (GDP) using the HCA, and from 2.3% to 3.6% of the GDP using the VSLY approach. The indirect economic burden is expected to reach 2.3 and 3.5 billion Intl$ by the year 2025 using the HCA and VSLY approach, respectively.

CONCLUSION: The indirect economic burden of cancer in Jordan amounted to 1.4%-3.6% of total GDP, with tracheal, bronchus and lung cancer; colon and rectum cancer; and breast cancer contributing to over 50% of the total burden. This will help set national cancer spending priorities following Jordan’s economic modernisation vision with regard to maximising health economic outcomes.

PMID:38830736 | DOI:10.1136/bmjopen-2023-082025

BMJ Open. 2024 Jun 3;14(6):e078198. doi: 10.1136/bmjopen-2023-078198.

ABSTRACT

OBJECTIVE: This study investigated the correlation between uncertainty stress (US) and depression among healthcare professionals (HCPs) in China.

DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional online survey was conducted by recruiting HCPs from three provinces in China (central, eastern and western) through purposive sampling between 29 September 2022 and 18 January 2023. US was measured using the Life Stress Questionnaire and depression was measured using the Patient Health Questionnaire-9. In total, 2976 questionnaires were deemed valid.

PRIMARY AND SECONDARY OUTCOME: This study examined the prevalence of US and depression among HCPs in China; the correlating sociodemographic traits; and the correlation between US and depression.

RESULTS: The prevalence of US and depression among HCPs in China was 26.54% (790 out of 2976) and 71.63% (2132 out of 2976). Binary logistic analysis revealed that individuals with graduate degrees (OR: 1.83; 95% CI 1.07 to 3.11; p<0.05), central China (OR: 1.75; 95% CI 1.36 to 2.24; p<0.01), primary medical institutes (OR: 1.33; 95% CI 1.03 to 1.72; p<0.05), secondary medical institutes (OR: 1.30; 95% CI 1.01 to 1.68; p<0.05), an annual income of less than ¥50 000 (OR: 1.85; 95% CI 1.26 to 2.73; p<0.01) and an income range of ¥50 000-¥99 999 (OR: 1.49; 95% CI 1.10 to 2.03; p<0.05) were associated with a higher likelihood of US. The adjusted logistic regression model demonstrated that HCPs with higher US had a greater likelihood of depression (adjusted OR: 5.02; 95% CI 3.88 to 6.50; p<0.01). The increase in the US score was paralleled by an increased depression score (beta (B): 1.32; 95% CI 1.25 to 1.39; p<0.01).

CONCLUSION: These findings reveal a significant correlation between US and depression among HCPs and suggest that improving the management of US may help reduce the prevalence of depression among HCPs.

PMID:38830732 | DOI:10.1136/bmjopen-2023-078198