BACKGROUND: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals.
OBJECTIVE: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions.
METHODS: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education.
RESULTS: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals.
CONCLUSIONS: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.

BACKGROUND: Regular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness.
METHODS: The researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed.
RESULTS: A total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases.
CONCLUSIONS: Teaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions.

In the Integrated Child Development Services (ICDS) project Chiri in India, interviews with 363 pregnant and lactating mothers and an examination of household records were conducted to learn the extent of their participation in the ICDS Programme activities and to identify obstacles to under- or non-utilization of these services. 62% of the women were currently involved in the ICDS Programme. 23.7% had never used ICDS services. The most frequented services were supplementary nutrition (97.3%), tetanus toxoid prophylaxis (89.3%), and iron and folic acid prophylaxis (87.1%). 62.8% of the women participating in the supplementary nutrition program participated more than 20 days/month. Since tetanus toxoid prophylaxis and iron and folic acid prophylaxis occurred one day/month with high participation, the workers could have used this day for group meetings, individual counseling, discussions, and demonstration, but the opportunity was missed for prenatal care, contraception, growth monitoring, and health and nutrition activities. 89.8% of women participating in the supplementary nutrition program took the food home to share with family members. Participation rates were less than 50% for organized radio listening (9.3%), Mahila Swasthya Sangh meetings (20.4%), birth spacing (40.4%), health and nutrition education (40.4%), family planning (46.2%), and prenatal care (47.4%). The major reasons for never using ICDS services were: could not spare time (53.5%) and working outside the household for long hours (50%). 15% were never approached by an anganwadi worker and were therefore not aware of ICDS services or the workers did not have an encouraging attitude. Other possible contributing factors to under- or non-utilization were high illiteracy (61%) and insufficient awareness of ICDS services among heads of households (94.9%).

Since 1979 in India, the health center in Malavani, a Bombay slum, has tried different methods to vaccinate the largest possible number of newborns and children. Methods used to vaccinate infants and children included clinic visits to subcenters or to a health center, vaccination of siblings of students at primary schools, visits in a designated place in the community, and home visits by a health center team with the participation of local leaders and benevolent organizations, with the participation of medical and paramedical students, by a health center team with no community participation, or by primary school students who persuaded mothers to take their children to the mobile vaccination unit. A review of the vaccination records shows that, in the case of first vaccinations for DPT (diphtheria-pertussis-tetanus) and polio conducted by door-to-door visits, follow-up vaccinations had been better and the costs lower when primary school students made home visits encouraging mothers to take their children to a mobile vaccination unit and with participation of local benevolent organizations. Overall, third dose coverage for these two vaccinations was higher with community participation (regardless of type of community participation) than without it (78% vs. 67%). Without doubt, community participation has a favorable effect on vaccination coverage.

During one morning in 1992 in Niamey, Niger, interviews with 380 women aged 15-49 attending five health facilities and with persons bringing 209 infants (0-11 months) to the same centers were conducted to identify weaknesses in the Expanded Program for Immunization in Niger and to define strategies to improve services. Missed opportunities for vaccination were used to evaluate these services. The health facilities were a maternal and child health (MCH) center, a dispensary, a national family health clinic, a social security health center, and a pediatric service at a central hospital. 27% of the infants lacked at least one vaccination. The corresponding figure for the women was 39%. The major types of visits were well-baby visits (45%) and curative visits (32%). The types of child vaccinations missed were all three DPT (diphtheria, pertussis, and tetanus) doses (30% for 1st, 23% for 2nd, and 27% for 3rd), measles (29%), yellow fever (27%), and BCG (15%). Among women, the third and fourth doses of tetanus toxoid were most missed (31% and 23%, respectively). 87% of the persons accompanying the infants and 86% of the women would have accepted the vaccination on the day of the survey had it been made available. Among infants, missed opportunities were more common at the social security health center (56%) and least common at the national family health clinic (5%). Among women, the MCH clinic and the dispensary missed opportunities to vaccinate the most (59%) followed by the national family health clinic (53%), the hospital (47%), and the social security clinic (33%). 88% of persons with the infants had the infant\'s vaccination card with them. On the other hand, only 9% of women had their vaccination card. Based on these findings, some recommendations were: guarantee a supply of vaccination cards for all women; systematically distribute cards to women aged 15-49 and inform them of the importance of bringing it with them when they visit health services; provide vaccinations every day in all health facilities; and re-evaluate vaccination stocks.

1000 women selected randomly in the Italian provinces of Roma and Latina were given a questionnaire seeking information on age, occupation, oral contraceptive (OC) use, self-examination of the breasts, frequency of visits to clinics and Pap test, parity, and family history of tumors. 98% of the women were familiar with the services offered by family planning (FP) units. 786 questionnaires were analyzed. 80% of the subjects were 35 years old: the 21-25 age group was most prevalent. 40% were employed, the rest were housewives or retired (according to official statistics in 1984 only 25.9% of women were employed). Visits to the gynecologist increased with advancing age but proved to be inadequate for prevention even in the age segment most at risk of acquiring malignant neoplasms (p .05). Women who stayed at home were most likely to have regular gynecological checkups and Pap tests. 24% of women answered in the affirmative about self-examination of the breasts, and the 26-30 age group was most interested in it. 31% of housewives also practiced it, compared to only 10% of those who worked (p .01). OC use was most prevalent in the 26-30 age group (over 30%), while those 35 and under 20 neglected its use. FP units play an important role in oncological prevention by observing cultural and social aspects of women\'s lives and by adapting preventive programs accordingly.

The youth activities of the Romanian family planning association, the Society for Education on Contraception and Sexuality (SECS), center on a youth camp at the seaside resort of Costinesti. A very small consulting room set up 1) to supply education information on contraceptive methods, family planning, STDs, and major sex problems, and 2) supplying condoms. Staff included 11 physicians of whom 3 were obstetrics specialists, 4 nurses, 1 biologist, 1 demographer, 2 economists, and 1 engineer. Within an 80 day period, there were 1345 consultations, or 17/day. 72% were males and 28% females. The explanations for the higher male rate were attributed to reservations of women toward sexual issues, a higher number of sexual problems and STDs among males, and the perceived need for condoms by men. 33.8% were 20-24 years and 17.5% were less than 20 years. 80% of the sexual problems were related to anxiety about unwanted pregnancy and the natural method of coitus interruptus. 77.4% had questions related to contraception. The next highest concern was for STDs at 12%; the negative image of STDs prevails. Other concerns were for sexual problems, anatomy and physiology, pregnancy and birth, and demographic problems in general. AIDs was a disputed topic. 1121 out of 1345 client acquired condoms, 95% of the men and 53% of the women. The requested purpose was primarily contraceptive; men were more worried about STDs than women. A workshop for girls 14-16 was conducted separately which discussed anatomy and physiology. Effective broadcasting from the local radio station increased the number of consultations. Another workshop with representatives from a yoga school also was held; topics were yoga as a contraceptive means, therapy for sexual problems, and benefit to AID\'s sufferers. The author concludes that knowledge is low and interest high for contraception.

The disparities between Pakistan\'s survey statistics which undercount and services which overestimate contributed to the impetus to develop indirect estimates of contraceptive use in 1975 and 1984 using m values in the polynomial regression equation. In 1975, the Couple Years Protection (CYP) was used and 1985 the Component Projection Approach of the UN. The suggested improvement is the use of PGE longitudinal and Chandra and Deming method with the PFSS fertility schedule, which meets the Coale and Trussell standards (the 1975 PFS values was a near perfect fit with a mean value of 0, and the 1985 estimated schedule was mediocre and the PGE mediocre to poor.). The methodology involved comparing indirect estimates of contraceptive use with estimates from service statistics and surveys. Coale\'s model of marital fertility is explained with natural fertility at age (a) and the logarithmic departure from natural fertility derived from averaging empirical data. In converting the degree of deliberate marital fertility control in a population (m) as an independent variable and the scale factors indicating the level of fertility with respect to average natural fertility (M), 2 second degree polynomial regression equations were generated. The results were that in equation 1 where Y = 87.637(x) - 26.873(x)squared, the estimated use in 1975 was 20.5 with an m value of .254 compared to 5.3% reported use and 16.8% service statistics use; underreporting is apparent. Equation 2 where Y = 86.776(x)- 27.286(x)squared use is 20.3% with an m value of .254 and the increase in variance explained by .98. The contraceptive use estimate of 20% is substantiated also by Nortman (1982) and Lee and Lucas (1986), who said that a Crude Birth Rate of 40 per 1000 corresponds to a prevalence rate of around 20%. The 1985 contraceptive use value of equation 1 and 2 were 20.7 and 20.4 respectively with m values of .256.

A vast family planning IEC program planned by Rwanda\'s National Population Office will depend on the work of the Abakangurambaga, workers elected by their local communities to inform and motivate the population toward rational use of the maternal-child health and family planning services. A preliminary study was begun in 1988 in 3 communes of the prefecture of Ruhengeri each having about 30,000 inhabitants. 23 trained workers in Gatonde informed the population about maternal-child health and family planning services and referred couples to the Gatonde health center. 23 trained workers in Kidaho informed the population about services, made referrals, and also supplied some contraceptive products including condoms, spermicides, and pills after the initial prescription at a health center. The commune of Kinigi served as a control. A preliminary evaluation study was conducted in Gatonde and Kidaho in June 1988, 3 months after the project was launched. Community workers, homes, and sector meetings were found to be the favored channels of communication. Married women in households with 4-6 children were most likely to be contacted by the workers. The numbers of persons individually contacted in Gatonde and Kidaho respectively were 221 and 1022 in March 1988, 312 and 1175 in April 1988, and 155 and 71 in May 1988. The workers in Kidaho resupplied a total of 342 clients with condoms, 73 with spermicides, and 15 with oral contraceptives in the 3 months. The total numbers of women using contraceptives varied between March 1988, when the project began, and May 1988, from 184 to 223 in Kidaho and from 300 to 634 in Gatonde. There was little variation in Kinigi. The number of new acceptors was 47 in March, 114 in April, and 32 in May in Kidaho; 82 in March, 178 in April, and 170 in May in Gatonde, and 2 in March, 7 in April, and 8 in May in Kinigi. The total number of couples using contraception had increased by May 1989, a year after the preliminary evaluation, to 267 in Kidaho, 1021 in Gatonde, and 516 Kinigi, The service statistics indicated that the Abakangurambaga are very effective in motivating the population to family planning use.

Interim progress in an integrated family planning and community health program instituted in 2 villages in Tanzania, compared to a control village, is presented. The target villages, in Masama and Arusha China, consisting of 10,000 and 8000 people, and the control village of Kisiki with 10,500 were all near Moshi town. The control village was provided with contraceptives, but given no integrated program activities. The program activities consisted of mass examination and deworming of adults and children, nutritional assessment of school children, latrine census and construction, health education, family planning and income generating projects. Traditional birth attendants as well as health clinics provided family planning education and services. Peoples\' health committees helped with the latrine surveys and income projects. Some of the popular income projects were raising all animals, especially rabbits, selling condoms, growing vegetable seedlings and making dresses, mats and baskets. Attendance at the clinic for family planning services grew from 20 to 76% of fertile women in Masama, from 25 to 103% in Arusha China, but remained at around 25-30% in the control village.