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Implementation of Kenya Electronic Medical Records (KenyaEMR): Costs and Efficiencies
Sebastian Kevany,
Starley Shade,
Chloe Waters,
Nancy Puttkammer
Issue:
Volume 11, Issue 5, September 2023
Pages:
143-153
Received:
29 March 2023
Accepted:
22 May 2023
Published:
6 September 2023
Abstract: Background: Electronic medical record (EMR) rollout is a key element of health systems strengthening activities. To facilitate national rollout and country ownership of KenyaEMR, we assessed costs associated with development and point-of-care implementation of KenyaEMR supported by the International Training and Education Center for Health (I-TECH) between April 2012 and September 2013. Methods: We reviewed and collated I-TECH costing records and considered KenyaEMR implementation costs through two lenses: (1) overall direct I-TECH project costs to characterize costs across resource category, activity and location; and (2) health facility-specific costs to estimate cost per facility and explore variation in costs across facilities. Results: KenyaEMR development and implementation during this period cost I-TECH US$3,803,810. Human resources represented the majority of costs (51%), followed by travel (25%), and equipment (10%). Deployment (34%), project management (33%), and training and capacity building (22%) made up the largest proportion of I-TECH KenyaEMR costs; software (9%) and curriculum (2%) development costs were lowest. In-country expenses made up 65.9% of costs; this proportion increased over time. I-TECH was able to initiate implementation in 204 facilities and complete an equivalent of 128 implementations. Implementation in a facility, from sensitization through installation and back data entry, cost an average of US$9,879. The cost per patient of KenyaEMR implementation decreased as the number of patients in a facility increased. Cost per patient was uniformly less than US$20 per patient in facilities with more than 700 patients. Conclusions: Human resources, rather than equipment and infrastructure, drove costs of KenyaEMR implementation. Implementation quickly transitioned to be country-led. We observed substantial economies of scale in implementation of KenyaEMR. Resource limited countries should prioritize of implementation of point-of-care EMRs facilities in larger health facilities. Additional research is needed to determine whether point-of-care EMRs improve efficiency or cost-effectiveness of HIV care and treatment in resource-limited settings.
Abstract: Background: Electronic medical record (EMR) rollout is a key element of health systems strengthening activities. To facilitate national rollout and country ownership of KenyaEMR, we assessed costs associated with development and point-of-care implementation of KenyaEMR supported by the International Training and Education Center for Health (I-TECH)...
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Parasitic, Fungal and Prions Zoonotic Diseases: A Public Health Nutrition Perspective and Policy Implication in Nigeria
Paulina Oludoyin Adeniyi,
Bassey Ekpenyong Anam
Issue:
Volume 11, Issue 5, September 2023
Pages:
154-164
Received:
25 June 2023
Accepted:
11 July 2023
Published:
13 September 2023
Abstract: Most of the communicable diseases in existence globally are zoonoses, hence, there is need to identify the benefits and demerits of these diseases for a better policy making and implementation towards improved public health. This is therefore a review of different parasitic, fungal and prions zoonotic diseases with emphasis on those that are food-borne with the identifiable pros and cons tailored towards policy implementation with a conceptual framework drawn out for Nigeria. The search engines accessed are: Google search, Google scholar, PubMed and HINARI. Zoonotic diseases can be classified based on the causative pathogens which are viruses, parasites, bacteria, fungi and prions. Some of the zoonotic diseases discussed are: Parasitic (African sleeping sickness, Angyostrongyliasis, Anisakiasis, Baylisascariasis or raccoon roundworm, Capillariasis, Parasitic eugenoids, Tapeworm or Taeniasis, Roundworm or Dirofilariasis, Echinococcosis or Platyhelminthes, Fasciolosis or Flatworm, Fasciolopsiasis, etc); Fungal (Cryptococcosis and Histoplasmosis); and Prions (Creutzfedt-Jacob disease). These diseases have associated merits and demerits. The pros as identified are: possibility of developing natural immunity against the disease in infected humans after recovery most especially in few viral zoonoses; outbreak of zoonosis may enforce proper channeling of resources for human benefits; outbreak of a zoonotic disease may also draw and command global attention to the endemic areas for aids; after an outbreak developed infrastructures, especially in the health sector, may be a trade off from an effective and prompt response to a zoonosis outbreak; there may exist a rapid concomitant technological and intellectual advancement due to the development of vaccines, drugs and other logistics to combat the disease as in the case of COVID-19. The cons are the ill health states which cause both measureable and non measureable reduction in quality of life, loss of lives and animals which are hazardous to human, animal and environmental sustainability, hence, a defective ecosystem that work against sustainable development. Zoonotic diseases are really with accompanied pros and cons which if properly considered and addressed may be helpful in adequate and effective policy making and implementation towards sustainable development.
Abstract: Most of the communicable diseases in existence globally are zoonoses, hence, there is need to identify the benefits and demerits of these diseases for a better policy making and implementation towards improved public health. This is therefore a review of different parasitic, fungal and prions zoonotic diseases with emphasis on those that are food-b...
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Environmental Health of the Sor María Romero Neighborhood of the Municipality of Matagalpa Nicaragua
Jonathan Delaniú Mejía Rivas
Issue:
Volume 11, Issue 5, September 2023
Pages:
165-173
Received:
26 August 2023
Accepted:
12 September 2023
Published:
8 October 2023
Abstract: This article describes the environmental health situation of the population of the Sor María Romero neighborhood of Matagalpa Nicaragua. Some determinants that were reviewed were exposure to the wastewater treatment plant, the municipal landfill and environmental practices in the inhabitants. Results: There is a direct relationship between living near the wastewater treatment plant and developing communicable diseases such as pneumonia and diarrhea. The perception of pollution to the environment are the bad odors coming from the wastewater treatment plant and the landfill located behind the neighborhood. Loss of taste, smell and flies are the complaints of the population, followed by the insecurity of the neighborhood by young delinquents. Conclusions: There is a relationship due to being exposed to the wastewater treatment plant and presenting diseases such as diarrhea, pneumonia, loss of smell and taste. In the community they do not see environmental and epidemiological problems as a priority since they do not perceive them as day-to-day problems, the priority are social problems such as insecurity, the availability of drinking water and the lack of good roads. Recommendations. To the authorities of Matagalpa to relocate the (PTAR) and to sensitize the population of caring for the environment.
Abstract: This article describes the environmental health situation of the population of the Sor María Romero neighborhood of Matagalpa Nicaragua. Some determinants that were reviewed were exposure to the wastewater treatment plant, the municipal landfill and environmental practices in the inhabitants. Results: There is a direct relationship between living n...
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Effect of PROLCARMIV on Management of Non-Communicable Diseases Among People Living with HIV in Busia, County Hospital-Kenya
Ruth Wamatuba Akelola,
Wamukoya Edwin,
Situma Jane
Issue:
Volume 11, Issue 5, September 2023
Pages:
174-185
Received:
8 September 2023
Accepted:
28 September 2023
Published:
14 October 2023
Abstract: Good Nutrition optimizes benefits of ART and increases treatment adherence, both prolong lives of PLHIV (NASCOP, 2014), without proper care and management it exposes them to non-communicable diseases (NCDs). Key objective; To determine the effect of food-based nutrition intervention on the management of NCDs among PLHIV in Busia. Design was experimental using randomized control trial approach. Control group- 30 subjects fed on Plumpy ‘nut while treatment group – 30 subjects fed on Power Porridge (PROLCARMIV), for 60 days. Subjects purposively selected from the Comprehensive Care Clinic (CCC) in Busia County referral hospital- Kenya, further randomly selected using simple random sampling, assigned equally to each group. Data collected using a structured questionnaire analyzed using Social Package for Statistical Sciences version 26. Prevalence of NCDS; 75.5% hypertension; 15.6% Diabetes and 8.9% heart disease; post-intervention BMI for intervention group increased; Laboratory analyses; Hb post–intervention results; mean levels were higher in intervention group (M=13.62, SD=2.69) p-value = 0.487 compared to control group (12.69, SD=1.24), p value= 0.471. RBS were higher in control group (5.96, SD=1.70), p value= <0.001, intervention group (M=5.79, SD=1.02), p-value = <0.001. Post-intervention liver function test; TB, AST, and ALT showed higher SD indicating variability. Lipid profile; showed TC mean (4.39 (0.95) for control group; a mean 3.78 (0.94) intervention group: p=0.017; HDL -control group mean 1.58 (0.57): 1.14 (0.53) intervention group p=0.036: TG - control group mean 1.50 (0.50): intervention group p= 0.017: mean 1.14: (0.46): LDL mean 2.26 (0.66) control group: 1.43 (0.42): intervention group p= 0.041: all exhibited significant decreases. Kidney function tests; no significant differences between the two groups. Conclusion; Compliance for PROLCARMIV; 82.5%, attracting uptake of CCC services. PROLCARMIV can manage NCDs among PLHIV, answering the alternative hypothesis, this would inform Policy.
Abstract: Good Nutrition optimizes benefits of ART and increases treatment adherence, both prolong lives of PLHIV (NASCOP, 2014), without proper care and management it exposes them to non-communicable diseases (NCDs). Key objective; To determine the effect of food-based nutrition intervention on the management of NCDs among PLHIV in Busia. Design was experim...
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