BACKGROUND: Electronic health records (EHRs) play an increasingly important role in delivering HIV care in low- and middle-income countries. The data collected are used for direct clinical care, quality improvement, program monitoring, public health interventions, and research. Despite widespread EHR use for HIV care in African countries, challenges remain, especially in collecting high-quality data.
OBJECTIVE: We aimed to assess data completeness, accuracy, and timeliness compared to paper-based records, and factors influencing data quality in a large-scale EHR deployment in Rwanda.
METHODS: We randomly selected 50 health facilities (HFs) using OpenMRS, an EHR system that supports HIV care in Rwanda, and performed a data quality evaluation. All HFs were part of a larger randomized controlled trial, with 25 HFs receiving an enhanced EHR with clinical decision support systems. Trained data collectors visited the 50 HFs to collect 28 variables from the paper charts and the EHR system using the Open Data Kit app. We measured data completeness, timeliness, and the degree of matching of the data in paper and EHR records, and calculated concordance scores. Factors potentially affecting data quality were drawn from a previous survey of users in the 50 HFs.
RESULTS: We randomly selected 3467 patient records, reviewing both paper and EHR copies (194,152 total data items). Data completeness was >85% threshold for all data elements except viral load (VL) results, second-line, and third-line drug regimens. Matching scores for data values were close to or >85% threshold, except for dates, particularly for drug pickups and VL. The mean data concordance was 10.2 (SD 1.28) for 15 (68%) variables. HF and user factors (eg, years of EHR use, technology experience, EHR availability and uptime, and intervention status) were tested for correlation with data quality measures. EHR system availability and uptime was positively correlated with concordance, whereas users\' experience with technology was negatively correlated with concordance. The alerts for missing VL results implemented at 11 intervention HFs showed clear evidence of improving timeliness and completeness of initially low matching of VL results in the EHRs and paper records (11.9%-26.7%; P<.001). Similar effects were seen on the completeness of the recording of medication pickups (18.7%-32.6%; P<.001).
CONCLUSIONS: The EHR records in the 50 HFs generally had high levels of completeness except for VL results. Matching results were close to or >85% threshold for nondate variables. Higher EHR stability and uptime, and alerts for entering VL both strongly improved data quality. Most data were considered fit for purpose, but more regular data quality assessments, training, and technical improvements in EHR forms, data reports, and alerts are recommended. The application of quality improvement techniques described in this study should benefit a wide range of HFs and data uses for clinical care, public health, and disease surveillance.

Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men\'s uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25-39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6-10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25-39 years. Additionally, preferences were influenced by individual\'s disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.

Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.

UNASSIGNED: Integrated nature-based interventions in healthcare facilities are gaining importance as promising health and biodiversity promotion strategies. This type of interventions combines the restoration of biodiversity in the vicinity of the healthcare facility with guiding patients in that natural environment for health outcomes. However, quality appraisal of these interventions is still poorly developed. Based on a recent scoping review, the authors developed a preliminary quality framework in support of healthcare facilities designing, implementing and evaluating integrated nature-based interventions. This present study aims to fine-tune the practical relevance of the quality framework within the emerging practice.
UNASSIGNED: A qualitative interview study was conducted in seven healthcare facilities in Belgium. Using a combination of snowball and purposive sampling, 22 professionals, involved in the integrated nature-based intervention in their facility, participated in the study. The semi-structured interviews were transcribed and imported into NVivo. A deductive and inductive thematic analysis was used to explore the practical relevance of the quality framework. A stakeholders\' assembly review and a member checking of the findings were also part of the study.
UNASSIGNED: Twenty-two interviews with nature management coordinators, healthcare professionals, and healthcare managers were conducted by three principal investigators in seven healthcare facilities implementing integrated nature-based interventions. The contextualization and complexity of integrated nature-based interventions in the participating healthcare facilities demonstrated the need for an evidence-based quality framework describing nature-based interventions. The study led to nine quality criteria, confirming the eight quality criteria derived from a previous scoping review, and the identification of a new quality criterion \'Capacity building, leverage and continuity\'. These quality criteria have been refined. Finally, a proposal for a quality framework was developed and operationalized in a checklist. Deployment of the quality framework should be embedded in a continuous cyclical, adaptive process of monitoring and adjusting based on evaluations at each phase of an integrated nature-based intervention.
UNASSIGNED: Bridging the domains of healthcare and nature management in the context of an integrated nature-based intervention in a healthcare facility requires a transdisciplinary approach. Scientific frameworks such as \"complex interventions,\" Planetary Health and One Health can support the co-design, implementation and evaluation of integrated nature-based interventions within a cyclical, adaptive process. In addition, the importance of the quality of the interactions with nature could gain from more sophisticated attention. Finally, the implications for healthcare facilities, policymakers and education are discussed, as well as the strengths and limitations of the study.

BACKGROUND: Depression is a severe and treatable mental illness that significantly affects individuals\' daily activities. Obstetric care providers are the most vulnerable group for depression because they work in an emergency to save two lives at a time, share the stress of women during labor, and are at great risk for contamination.
OBJECTIVE: To assess depression and associated factors among obstetric care providers working in public health facilities.
METHODS: A cross-sectional study was conducted among 423 obstetric care providers working in public health facilities found in the West Arsi Zone, Ethiopia, from June 1 to 30, 2023. Study participants were selected through a simple random sampling technique. A pretested, face-to-face interviewer-administered structured questionnaire was used to collect data. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with depression. The level of statistical significance was declared at P < 0.05 with a 95% CI.
UNASSIGNED: Overall, the prevalence of depression among obstetric care providers was 31.1% (95% CI: 26.6%, 35.5%). Marital status not in union (AOR = 2.86, 95%CI: 1.66, 4.94), working more than 40 hours per week (AOR = 2.21, 95%CI: 1.23, 3.75), current substance use (AOR = 2.73, 95%CI: 1.64, 4.56), not being satisfied with their job (AOR = 3.52, 95%CI: 2.05, 6.07) and having burnout symptoms (AOR = 5.11, 95%CI: 2.95, 8.83) were factors significantly associated with depression.
CONCLUSIONS: We recommend that health professionals take care of themselves and avoid substance use. We also recommended that stakeholders enhance job satisfaction and avoid burnout by implementing various programs, like raising wages for workers, increasing staff members, offering various benefits, and regularly monitoring issues that arise.

BACKGROUND: A negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia.
OBJECTIVE: This study aimed to assess health care provider\'s attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia.
METHODS: A health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant.
RESULTS: The response rate of the study was 99.3%, and 70.2% [95% CI: 65.6-74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25-29, 30-34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03-10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43-19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55-6.60], midwives [AOR = 6.50, 95% CI = 2.40-17.44], working at hospital [AOR = 4.77, 95% CI = 1.53-14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29-11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13-5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23-16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15-13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52-24.26] were associated with a favorable attitude towards safe abortion care.
CONCLUSIONS: Healthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units.

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.
METHODS: A facility-based cross-sectional study design.
METHODS: 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.
METHODS: 628 pregnant women of any gestational age who had been on ANC follow-up at selected public health facilities were included.
METHODS: 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.
CONCLUSIONS: 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.

UNASSIGNED: Self-harm is a preventable, but a leading, cause of maternal morbidity and mortality all over the world, with a significant impact on healthcare systems.
UNASSIGNED: To assess the magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics.
UNASSIGNED: An institution-based cross-sectional study was employed among postnatal mothers attending infant immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 1 October to 30 October 2023. A pretested, face-to-face interviewer-administered structured questionnaire prepared by Kobo Toolbox was used to collect the data. Both bivariable and multivariable logistic regression analyses were done. The level of significance was declared at p-value <0.05 with a 95% CI.
UNASSIGNED: Among the 423 mothers enrolled in the study, 415 of them finally participated, at a response rate of 98.10%. The magnitude of self-harm was 12.53% (95% CI: 9.33, 15.73). Involvement of husband in maternity and child healthcare (AOR = 1.90; 95% CI: 1.12, 2.10), depression (AOR = 2.79; 95% CI: 2.14, 6.94), loneliness (AOR = 2.49; 95% CI: 1.15, 5.40), postpartum intimate partner violence (AOR = 2.15; 95% CI: 1.01, 4.54), average monthly income (AOR = 3.70; 95% CI: 2.17, 10.50), and postnatal care (AOR = 2.72; 95% CI: 1.28, 5.80) were significantly associated factors.
UNASSIGNED: The study sought a magnitude of self-harm that was slightly higher than the previous study conducted in the northern part of Ethiopia. Therefore, healthcare providers should focus on identified factors during postnatal care to overcome them. Similarly, the concerned body should develop an effective strategy based on the identified factors to pay attention to postnatal mothers.

UNASSIGNED: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.
UNASSIGNED: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.
UNASSIGNED: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.
UNASSIGNED: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.
Main findings: Variation in under-vaccination rates between health centers contributes to worsening performance overall and in urban and rural areas.Added knowledge: Our study indicates that one of the paths to improving under-vaccination and consequently total coverage is by addressing the factors driving under-vaccination and its inequity between health facilities.Global health impact for policy and action: Children with delayed or non-vaccination history at four months of age, those due for vaccination in the rainy season especially in urban areas, and health facilities with very small or big birth dose to health worker ratios are potential targets for improving under-vaccination.

BACKGROUND: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.
METHODS: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.
RESULTS: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.
CONCLUSIONS: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.