Modelling the Number of Household Visit to Health Care Centres in Some Nigeria Communities Using Count Data Regression Models

Introduction: The need to model the impact of some demographic indicators on the frequency of household visits to healthcare centres in Nigeria's community is very important for preventing and spreading community diseases. This study aimed to investigate the effect of the patents' age, gender, marital status, type of illness and amount spent on the frequency of visits to community health care centres in Nigeria and to compared Negative Binomial Regression (NBR) and Generalized Poisson Regression (GPR) models to determine the preferred count regression model for the number of household visits to health centres in some communities in Nigeria. Methods: Survey of 132640 households in some Nigeria communities obtained from the 2018/2019 Nigeria Living Standard Survey (NLSS) were extracted from the National Bureau of Statistics (NBS) in collaboration with the World Bank. The Negative Binomial and Generalised Poisson regression models were used to investigate the five demographic variables on the frequency of visit to the community health centres. The performance of the count regression model was assessed using the Chi-square -2log Likelihood Statistic (2logL), Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) selection criteria. Results: Findings from the study showed that the type of illness and amount spent has a significantly positive effect on the number of household members' visits to the community health care centres in Nigeria while age, gender, and marital status was discovered to have a negative effect on the number of household members' visits to the community health care centres in Nigeria. Conclusion: The Nigeria Government, health centre management and community healthcare service providers' need to be aware that the amount spent and the nature of illness determines the level of health care services utilisation in the Nigeria community, hence the need for the drastic reduction in charges to encourage a household visit to the community health centres whenever the need arises.

Mixed methods process evaluation of the Sundara Grama intervention promoting latrine use and safe disposal in rural Odisha, India

BackgroundProcess evaluations of public health programs are critical to understand if programs were delivered as intended and to identify improvements for future implementations. The aim of this paper is to describe a mixed methods process evaluation of the Sundara Grama intervention, which sought to improve latrine use and safe child feces disposal among latrine-owning households in rural Odisha, India.MethodsThe Sundara Grama intervention was delivered to 36 villages in Puri district by a grassroots NGO and included eight activities: palla performance (folk theater ‘edutainment’), transect walk, community meeting, community wall painting, mother’s meeting on child feces disposal, positive deviant household recognition, household visit, and latrine repairs. The process evaluation quantitatively assessed fidelity, dose delivered, and reach, and qualitatively examined recruitment, context, and satisfaction. Quantitative data collection included an activity observation survey, activity record, and endline trial survey. Qualitative data collection included an activity observation debrief and in-depth interviews with NGO mobilizers. Data collection took place during three time periods: during intervention delivery, immediately after, and several months post-implementation. For the quantitative data, a ‘delivery score’ was calculated for each activity, as well as the proportion of target participants in attendance. Qualitative data was analyzed using thematic analysis.ResultsMean delivery scores, reported as a percentage, were moderate to high. Household visit activities (97% general visit, 96% positive deviant visit) and the mother’s meeting (81%) had the highest delivery scores, followed by the palla (77%), transect walk (77%), and community meeting (60%). Activities were attended, on average, by 30–73% of latrine-owning households. Several factors aided delivery, including pre-intervention rapport building visits and village stakeholder support. Factors that hindered delivery included inclement weather, certain recruitment strategies, and village social dynamics related to caste and gender. With regard to satisfaction, participants and NGO mobilizers praised the palla but reported mixed reactions to other activities.ConclusionsOverall, the Sundara Grama intervention was implemented as intended and achieved good reach. The findings suggest edutainment and multi-level communication approaches are particularly beneficial, and offer lessons for community-wide programs on the importance of examining the implementer experience and broader context.Trial RegistrationThis trial is registered at clinicaltrials.gov: NCT03274245.

Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study

ABSTRACTTuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4–0.9; P = 0.009) and patients living in Cali’s western zone (aOR: 0.5; 95% CI: 0.3–0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1–66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2–15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.

Analysis of factors influencing the frequency of primary care visits among diabetic patients in two provinces in China

Background Community health services have played an important role in the prevention and control of diabetes in China. The aims of this study were to examine the frequency of visits to community clinics for diabetic care services, to assess factors correlated with infrequent primary care visits and to identify barriers to regular follow-up visits for urban and rural patients. Methods Between October 2014 and November 2014, data were collected from 17 communities in two cities and four townships located in Shandong and Jiangsu Provinces in China. A total of 1598 diabetic patients aged 18 years or older who were registered with a primary health station in local communities were selected by simple random sampling. Each participant was required to complete an interviewer-led questionnaire. Univariate and multivariate analyses were used to identify significant factors for infrequent visitor status using multivariable logistic regression analysis. Results After being clearly informed of the study protocol, 1508/1598 (94.4%) patients agreed to participate in this survey. Among the 1508 subjects (mean age 64.4 ± 10.6), 683 (45.3%) were classified as infrequent visitors. The following were significant factors determining infrequent visitor status: urban residence, lack of health insurance, per-capita household income< 20,000 (yuan), lack of telephone follow-up and lack of household visit. From the patients’ perspectives, the reasons for infrequent visits among urban patients included drug scarcity and longer travel time to clinics. For rural patients, worries about medical expenses and drug scarcity were the most common barriers to clinic visits. Conclusion Determinants of infrequent community visits in diabetes patients include urban residence, lower household income, lack of health insurance, lack of telephone follow-up and lack of household visit services. Strategies aimed at enhancing the utilization of community health care should be implemented in China.

Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

The dynamic nature of group A streptococcal epidemiology in tropical communities with high rates of rheumatic heart disease

SUMMARYProspective surveillance was conducted in three remote Aboriginal communities with high rates of rheumatic heart disease in order to investigate the epidemiology of group A β-haemolytic streptococci (GAS). At each household visit, participants were asked about sore throat. Swabs were taken from all throats and any skin sores. GAS isolates wereemmsequence and pattern-typed using standard laboratory methods. There were 531 household visits; 43 differentemmtypes and subtypes (emmST) were recovered. Four epidemiological patterns were observed. MultipleemmST were present in the population at any one time and household acquisition rates were high. Household acquisition was most commonly via 5- to 9-year-olds. Following acquisition, there was a 1 in 5 chance of secondary detection in the household. Throat detection ofemmST was brief, usually <2 months. The epidemiology of GAS in these remote Aboriginal communities is a highly dynamic process characterized byemmST diversity and turnover.