services across socio-economic groups, but did not ensure that all women benefited from the services . These ob- servations highlight the importance of also focusing on policies aimed at addressing other barriers. For instance, the current strategy of community provision of some MSRHS such as contraceptives, ANC, and postnatal care through mobile outreaches and local community struc- tures, including traditional birth attendants, community health workers and village health teams, is a welcome model for delivering services, and needs to be strength- ened. Furthermore, the level of engagement of the health system and other key community structures with males in the community on the importance of utilisation of MSRHS, including contraceptive uptake, also has to be in- tensified. Men might not have been appropriately engaged on these issues, and their knowledge of the services may be erroneous, which possibly accounts for the level of resistance that has been observed among some men vis- à-vis the uptake of MSRHS. Health providers might there- fore have to coin their messages more efficiently to enhance male partner support for the utilisation of mater- nal and child health services. For example, a study of Northern Uganda concluded that the introduction of community and health facility capacity strengthening in- terventions such as training of health workers, provision of medical supplies including delivery kits, and commu- nity mobilization using village health teams, dance, drama and “male partner access clubs”, led to improvements in first ANC visit attendance, in VCT service uptake for at- tendants of first ANC visits, in facility delivery, and in VCT service uptake by couples . While the current free healthcare policy for pregnant women and children under five has had a positive influence on the number of women going for ANC and facility delivery, other associ- ated expenses such as transportation to the health facility, food to eat, clothes for the baby and the mother, and care for the other children at home when the mother is away continue to prevent some women from utilising ANC and facility-based delivery services. Similar observations in Timor-Leste are reported by Wild et al. . In war-torn Afghanistan, Hadi et al. found that with appropriate con- ditions in place, many women and families will continue to seek facility-based delivery . These conditions in- clude providing free services and transport facilities at night, incentives to health providers, maintaining privacy in the delivery room, and the quality of services.
14 Read more
Nakuru County is one of the 20 high prevalence HIV burden counties in Kenya at 5.6% among mothers attending antenatal care clinics (NASCOP, 2012). The study was carried out in Nakuru County Referral Hospital which have the highest prevalence of HIV among women attending PMTCT clinic at 5% in 2013 and 11% in 2014 (DHIS Kenya, 2014). There was a mismatch in HIV-Exposed Infant (HEI) enrolment in PMTCT program and coverage of key HEI services. A total of 384 HEI were enrolled in PMTCT program where 354 were retained up to 18 months, 30 were lost to follow up (LTFU). The aim of the study was to assess the association between maternal, psychosocial and social-cultural determinant of service uptake among HIV-exposed infants in PMTCT program. The findings of this study will be useful in addressing the priority area of scaling up timely service uptake among HIV -exposed infants.
74 Read more
Background: Family planning is an efficient and effective intervention that results in quick benefits for the whole family socio-economically. Differences exist in the rate of contraceptive use between male and female and male in- volvement of service uptake in Ghana. The objective of this study was to ex- plore male direct involvement and or support to their partners in family planning service uptake. Methods: The study used a descriptive cross-sectional survey to sample 384 men of reproductive age (18 - 45 year) using cluster sampling to enlist participants from within the Suame Magazine light Indus- trial area in the Ashanti Region of Ghana. Data was analyzed descriptively us- ing SPSS version 16. Results: Men showed very high knowledge (90%) about what constitutes Family Planning, with moderate level of involvement both ac- tive and passive involvement (56%) though only a few (38.9%) were presently adopting or using modern contraceptive. The study rather found only 14% (55) males were willing to be solely responsible and actively involved in Family Planning service. Family Planning services did not adequately meet the needs of men with the services centers remaining unavailable in the study area. Con- clusion: The extent of male involvement in family planning programmes is marginally above average. Males showed appreciable knowledge of family planning options though misconceptions continued to exist. A more cou- ple-oriented approach to family planning is needed including recruiting males as family planning providers, offering more family planning counseling for couples, and promoting female-oriented methods with men and vice versa.
12 Read more
Group sessions were facilitated by UK and Filipino researchers (CH, EB, EG, JD), in which (i) participants responded to questions by creating a human scatter graph indicating their level of agreement to different statements by their physical proximity to the statement placed on the floor, creating an instant visual of the group’s perception and experience of mobile games and games for health; (ii) group discussions were held on design and technical enablers and barriers to digital gaming; and (iii) participants were divided into teams (max. 6 participants in a team), to develop pitches for games to promote HIV services, which they then presented and discussed. HIV clinic counsellors were present at both workshops to answer any questions the participants had regarding HIV and provided information on HIV service provision in the Philippines. The session was audio recorded and transcribed and photos were taken to record the human scatter graphs and visuals from the game pitches.
24 Read more
Homa-Bay County is the leading County in Kenya with an HIV prevalence of 25.7% compared with the national prevalence of 5.6%. (NACC, 2014). Boda-boda operators are a high risk group who involve themselves in HIV risk behaviours such as having sex with multiple sex partners, low condom use with non-regular partners, use of drugs and alcohol (NASCOP, 2005). There is also documented evidence of boda-boda operators giving free rides to clients in exchange for sex (NASCOP, 2005). These among others put this group at risk of HIV infection. The role of transportation drivers, particularly long-haul truckers and CSWs in the spread of HIV/STI has been studied in many settings. However, most of these studies focus on risk behaviors and the epidemiology of HIV/STI among truck drivers (Kohli et al, 2017). For example, research has shown that transport workers have specific healthcare needs due to the nature of their work which includes dispropotionate healt burden, including high rates of STI and HIV, respiratory diseases, backache, leg pains etc (CDC, 2007). The occupational circumstances that make them susceptible to worst health outcomes include irregularschedules, sedentary lifestyles due tolong hours of driving/sitting and poor access to health care (Aniebui & Aniebui, P,. & Aniebui, U, 2009). Very few data are available on HIV/STI prevention programs among transportation drivers (few studies such as Morris and Ferguson (2005) and Strauss et al, (2018) have been done in the country to look at service utilization) and, specifically on patterns of utilization of HIV preventive services among boda-boda operators.
Our results suggest that improving health care is pos- sible in very small rural health facilities in low-income settings without provision of external resources. Our findings further demonstrate that quality improvement principles and approaches can be applied to target in- creasing access and improving adherence to standards at points of care. Overall, our results provide further evi- dence for the value of quality improvement approaches in health care service delivery in low-income countries as a core part of the repertoire of strategies aimed at accelerat- ing efforts towards achievement of the health related mil- lennium development goals. Longer follow up studies are however needed to elucidate how such strategies can be sustained and their impact on core outcomes such as ma- ternal and neonatal mortality among others.
This study has highlighted areas of the health system that can be modified to maximize uptake of circumcision services. In relation to demand creation, participants felt that using age- and gender-appropriate mobilizers and community leaders was a more effective strategy than mass media campaigns. Participants felt that improved access to VMMC clinics would facilitate service uptake, as would designating men’s clinics for VMMC service delivery. Providing comprehensive pre- procedure counseling and education, outlining the benefits and disadvantages of the surgical procedure, and describing the differences between both the surgical and non-surgical pro- cedures were suggested. These health systems modifications to demand creation, access to services, and service delivery hold promise for increasing uptake of VMMC.
Using a large national health survey data set from India, we examined the association between the presence of a SHG and maternal health service uptake measured through institutional delivery, feeding colostrum to new- born, knowledge and use of family planning (after controlling for individual and village level factors). Our study shows respondents from villages with a SHG were more likely to have delivered in an institution, fed new- born with colostrum, and known about and utilized family planning products and services. These groups give the communities an avenue to voice their concerns and provide a unique space in which solidarity is created through promoting shared visions and goals and combining collective strengths. The presence of trust and social capital empowers communities and positively influences individual and community health. However, on their own, SHGs can have only limited impact. This Table 4 Stepwise logistic regression of knowledge of family planning
to see how much water can be absorbed, which mainly depends on the hydrophilicity of the fiber. The fiber before immersion in SBF was cut into (2 × 1) cm 2 and immersed in deionized water. The fiber was removed at the interval of 1 min, wiped gently with clean tissue paper, and weighed. The process was repeated for 10 min. The water uptake of the fiber after immersion in SBF was measured similarly at different intervals of 3, 7, and 14 days. The water uptake was calculated using the following equation :
Occupational status was an independent predictor of cervical cancer screening service utilization. Government employee women were more likely to be screened when compared to housewives. This finding was similar to the study conducted in Nigeria, which shows employed women utilize cervical cancer screening service more likely than unemployed women . This might be be- cause the majority of employed women have higher edu- cational status and they have access to information about cervical cancer and screening service from different sources. Also, this study showed that knowing someone who was ever screened for cervical cancer was associated with cervical cancer screening service utilization. Women who know someone ever screened were more likely to undergo cervical cancer screening when compared with women who do not know someone screened for cervical cancer. This result was consistent with the study done in Uganda . This might be due to screened women dis- cuss with unscreened women about the screening service, procedures, and the time it takes which decreases fear of women towards undergoing screening.
10 Read more
pattern of tracer uptake produced at the bone-prosthesis interface. A ﬁnal diagnosis was made by a combination of joint aspiration microbiology and clinical follow-up for 1 year; in addition to C-reactive protein and erythrocyte sediment rate levels as well as peripheral white cell count. NaF PET results were compared with 3-phase dynamic bone scan results and plain radiographs. The degree of uptake in the symptomatic joint exceeded background levels and also levels of uptake in the asymptomatic knee. The pattern of uptake and curve slope in both the asymptomatic and symptomatic joints matched the pattern of uptake in our hypothesis. Dynamic 18 F-NaF PET-CT
While crowdsourcing has been used to increase HIV testing and condom use, [23, 24] this innovative type of intervention has not been previously applied to HBV and HCV test promotion. By disseminating test promo- tion materials through social media and encouraging participants to generate content, this crowdsourced intervention has the potential to reach previously underserved MSM and improve hepatitis testing among a population with poor test uptake. Additionally, social media platforms are frequently used by MSM inside and outside China to share content, including health promo- tion materials . The results of this trial will therefore have implications for future hepatitis testing campaigns targeting MSM in settings with wide-spread social media utilization.
In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through spe- cialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and at least twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services). Since the publication of the UK government's coronary heart disease national service framework , regular audit of heart failure treatment is an explicit component of clinical governance activities in all NHS hospitals. Routine health data, such as HES and mortality data, are available at the local (NHS Trust and Primary Care Trust) level. Open-access web-based resources, such as Clinical Evidence , can be easily used to help identify effectiveness estimates from the literature. We suggest that local use of information from audit, rou- tine administrative data and the literature can help esti- mate the impact of different heart failure interventions and inform rational planning of relevant healthcare serv- ices, as it can provide realistic estimates of expected outcomes.
10 Read more
In this paper, we employ potentiality theory  from the field of anthropology to examine how the develop- ment of GCO was regarded by key agents involved in sexual health services (HCP, administrators, policy- makers, and community-based sexual health service providers) to prospectively impact STI testing service provision for both providers and clients. Taussig and colleagues describe potentiality as “a hopeful idiom through which to imagine the benefits of new medical interventions”, while also often concurrently reflecting biomedicine’s “increasing anxiety about the negative potentials of life”, such as injury, disease, aging, or death at both the individual and population levels (, p. S4). Online health services are a rapidly growing component of public health provision, including testing for STBBI. In general, HCP, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients’ agency; providing testing to more clients in a cost-effective manner) . However, the promise (i.e., the imagined benefits) of online health services may vary across contexts. Potentiality theory is especially useful for understanding context-based issues affecting implementation as it provides a useful framing to help unpack perceptions of GCO – be they positive, negative or ambiguous (e.g., enhanced appeal to young people; risks to ‘gold standard’ care provision; loss of provider control over an intervention; uncertainty re- garding budget implications). Asking stakeholders about the anticipated effects of implementing this new intervention offers a way to examine potential gaps “be- tween what is and what might, could, or even should be” (, p. S5). GCO’s hypothetical future can be ar- ticulated in positive, negative, or ambiguous ways, de- pending on how it is perceived. Understanding the ways in which the promise of GCO is perceived is a useful feature of context that provides another window into the ways in which context affects its continued im- plementation and adaptation.
11 Read more
In this study, we sought to add insight as to how much added value the service would offer over alternative or more basic approaches. The evidence briefing service as constituted represented a resource intensive intervention. There was sustained engagement by individuals in the CCGs receiving the evidence briefing service, and because we employed a degree of flexibility in the service delivered (employing a combination of full evidence briefings and shorter more exploratory evidence notes in response to questions raised), we were able to deliver a number of out- puts beyond our original. However, impact on explicit in- strumental decision-making processes was limited. Whilst we recognise that conceptual use of research to raise aware- ness and increase knowledge is an entirely appropriate goal in itself, we would question whether this represents a suffi- cient level of impact to justify sustaining a resource inten- sive intervention of this type.
12 Read more
London population is generally characterised by higher rates of mobility, ethnic diversity and an increased rate of social deprivation culminating in many hard to reach women and thus, negative impact on breast cancer screening uptake.  Our result shows that letter invitations combined with SMS reminder was most effective intervention in improving breast cancer screening uptake in the Royal Borough of Greenwich PCT, which traditionally had low screening uptake (see table 3 above). An overall 2.54 percent point increase coverage that was achieved may be seen as moderate increase in screening uptake but the impact on health outcome is huge, considering the fact that in UK around 11,600 women died from breast cancer in 2012; amounting to about 32 deaths every day.  Also, increased coverage for any breast cancer screening programme is an important measure of the performance of the screening intervention.  Thus, the result is significant and may have significant impact on the choice of reminder system for cancer screening in other Primary Care Trusts (PCTs) in London with similar hard to reach communities.
Nitrogen uptake in rice grain as well as total N uptake in rice significantly decreased with rise in temperature (Fig. 3 and 4). Grain N uptake was 0.9 g pot -1 with 0ºC and 0.8ºC temperature elevation. Temperature rise beyond 0.8ºC reduced N uptake in rice grains and at 3.9ºC rise in temperature grain N uptake was 0.6 g pot -1 . Total N uptake reduced from 1.5 g pot -1 to 1.1 g pot -1 with 3.9ºC rise in temperature.Although grain N uptake and total N uptake decreased significantly in all the elevated temperature treatments but the impact was reduced to some extent with N treatments. In each case maximum uptake was found to be with N2 dose (Fig. 3 and 4). Reduced root biomass, root length and above ground biomass at higher temperature has resulted in lower N uptake of the crop.
The service started in late November 2017 and was provided through ten community pharmacies contracted to NHSE S&S that had signed the Service Level Agree- ment (SLA). These pharmacies were selected for the service on the basis of having responded to a call for expressions of interest and meeting pre-defined criteria. These included that the pharmacies had to have an accredited consultation area approved for delivery of advanced services (i.e. clearly signed as a private consult- ation area, where the patient and pharmacist can sit down together and talk at normal speaking volume with- out being overheard by staff or customers) and that two pharmacists from each pharmacy had completed be- spoke, online and face-to-face training on diagnosis and management of the ENT and eye conditions. The training was developed and delivered by a team that in- cluded two GP trainers in examination skills and pharmacist facilitators. This included training pharma- cists on recognising ‘red flag’ signs and symptoms poten- tially indicative of a more serious condition, diagnosis in vulnerable groups and how to use diagnostic equipment (otoscope, torch and digital ear thermometer). Partici- pating pharmacies were supplied with the additional equipment necessary (e.g. an otoscope) and were able to provide the service to a limited number of patients each, based on the funding secured. The service was funded by the North West Midlands Urgent and Emergency Care Network, which included the training and supply of additional equipment, and project managed by Local Pharmaceutical Committees (LPCs). Additional top-up funding was awarded to the project by NHSE S&S Local Professional Network for pharmacy.
In recent years, ethnicity has come to the forefront as an important determinant of poor MCH outcomes in China [11–13]. In a large national study reporting data for 1996 and 2012, children living in some eth- nic minority counties had much higher infant mortal- ity rates than children living in majority Han counties [12, 14]. In a study examining variation in maternal mortality between 1997 and 2014, the ethnic compos- ition of the province was an important independent determinant of maternal mortality . Apart from ecological comparisons where the geographically de- fined groups might be too diverse in ethnic compos- ition to make meaningful comparisons, a recent systematic review also reported individual ethnic groups in China perform far worse than their Han counterparts in MCH outcomes and service coverage . China ’ s 55 ethnic minorities are by no means homogeneous, however, and they represent diverse so- cioeconomic positions, languages, religions, and cul- tural and geographic contexts [16, 17]. Nearly three quarters (71.4%) of all ethnic minorities in China live in the Western Region , some of whom reside in remote mountainous areas with difficult access to care [18, 19]. Others, such as the Manchu or the Hui are much more urbanized, and their health status may not be that different from that of the Han .
15 Read more
of the respondents in Kenya. Most of the respondents went for the test only because it was a doctor’s recommendation. Other factors that were contributory included having no living child, recent HIV diagnosis and the awareness of HIV related infections. Another study in Nigeria indicate that HIV-positive women are willing to screen for cervical cancer and that the integration of reproductive health services into existing HIV programs will strengthen rather than disrupt the services . The median age at diagnosis for cervical cancer is in the late 40`s and benefits of screening with avoiding cervical cancer cases has been shown most useful for women between 40 -60 years . Education increases the uptake of preventive care for several reasons, because better-educated individuals have a higher efficiency in the production of health and education as well imparts self-efficacy, confidence, motivation, patience and social inclusion . Number and age of children one has could also influence uptake of cervical cancer. This is because if a woman has many young children, she will have time constraints for screening as she has to rush back to cater to them 8 . Females with partners will be more likely to