Högskolan i Skövde

Background: Accreditation is a prerequisite for scientific management of the health system, owing to its numerous benefits on health centres’ performance. The current study examined Iran’s primary healthcare accreditation program to ascertain the challenges to its successful implementation. Methods: This qualitative study examined the perspectives of 32 managers and staff members in the pilot accreditation program (from the Ministry of Health and Medical Education, Semnan University of Medical Sciences, and Aradan District Health Network). Three in-depth group interviews were conducted using a semi-structured questionnaire, and the data obtained were assessed using thematic analysis. As a result of this investigation identified six themes, 29 sub-themes, and 218 codes as challenges to the successful accreditation of primary health care in Iran. Results: Six main themes, including “organisational culture”, “motivational mechanisms”, “staff workload”, “training system”, “information systems”, and “macro-executive infrastructure”, were identified as the main domain of challenges, with seven, five, two, four, three, and eight sub-themes respectively. Conclusion: Accreditation of PHC in Iran faces significant challenges and obstacles that, if ignored, can jeopardise the program’s success and effectiveness. By identifying challenges and obstacles and making practical suggestions for overcoming them, the findings of this study can aid in the program’s successful implementation and achievement of desired outcomes. 

Background: Multiple sclerosis (MS) is one of the critical diseases due to its adverse clinical, social, and economic consequences for affected people. This study aims to assess the quality of life (QoL) of patients with MS in East Azerbaijan, Iran. Methods: This cross-sectional study was conducted using the multiple sclerosis quality of life-54 (MSQoL-54) questionnaires to interview 300 randomly selected MS patients in East Azarbaijan Province, Iran. The independent t-test, analysis of variance (ANOVA), and Tukey post hoc test were used to examine the relationship between demographic variables, and QoL, and all analyses were performed using SPSS software, version 19. Results: The QoL score in MS patients is 48.22±22.48. The “life satisfaction” is the best and “physical role limitation” is the worst QoL aspect. Significant relationships were observed between marital status, education level, employment status, age of symptoms onset, and years of illness with QoL (P<0.05). Conclusion: The QoL of the MS patients in East Azarbaijan Province is lower than in other parts of Iran and much lower than in Organization for Economic Co-operation and Development (OECD) countries.

BACKGROUND: War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. METHODS: This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. FINDINGS: A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. INTERPRETATION: The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.

Objectives: To assess the current status of injury prevention (IP) core competency among medical students majoring in public health in China and to advocate for incorporating IP in the medical curriculum. Methods: The study used purposive sampling in eight medical universities in China in 2017, including 420 undergraduates and 763 graduates, using self-Administered questionnaires based on the core competency instrument for IP with five domains (31 items): A) injury analysis and assessment (8 items), B) IP project planning and implementation (7 items), C) communication (6 items), D) community practice (5 items), and E) leadership and systematic thinking (5 items). The higher score indicated the higher level of proficiency of the ability (scores ranged from 1 to 5). We used linear regression model to test the effect of IP course experience on the core competency mean score after adjusting for potential confounders. Results: The total mean score was 2.78 (SD=0.76, median=2.9, range=1-4.55) and 2.68 (SD=0.75, median=2.81, range=1-4.45) for undergraduates and graduates, respectively. There were 60% and 36% of undergraduates and graduates who have ever taken IP course, respectively. IP course class hours were positively associated with core competency level (P<0.05) across five domains (except for domain D) and the total. Conclusion: The core competency level is relatively low among public health students in China. Setting IP courses should be considered as an effective way to improve students' core competency. It is a step moving towards the IP education promotion, and further boosting the field of public health. 

This study aimed to investigate the prevalence and causes of childhood blindness in a rural area of Bangladesh. We adopted a cross-sectional quantitative study design for this study, which was performed in three unions (sub-districts) located in Raiganj Upazila of the Sirajganj district in Bangladesh. Using a validated tool, a screening program was conducted at the household level. After initial screening, a team of ophthalmologists confirmed the diagnoses by clinical examinations. The prevalence of childhood blindness was observed to be 6.3 per 10,000 children, whereas the rate of uniocular blindness was 4.8 per 10,000 children. Congenital problems were the major causes of both uniocular and binocular blindness (uniocular blindness: 84% and binocular blindness: 92%). The whole globe was the site responsible for binocular blindness (28.0%, 95% confidence interval [CI]: 13.1, 47.7), whereas the cornea was responsible for uniocular blindness (57.8%, 95% CI: 35.3, 78.1). Childhood blindness is a public health problem in Bangladesh and is highly prevalent, regardless of sex. The major causes of childhood blindness are congenital.

Introduction: The use of seat belts has made a significant contribution to the reduction of road traffic casualties, and the risk inherent with not wearing seat belts in all seats of a vehicle is now well-known worldwide. The use of seat belts has a major role in reducing fatal and nonfatal injuries in all types of motor-vehicles crashes. Aim: The aim of this study is to understand the reasons behind the variation in seat belt use over the past two decades in Lebanon. It analyzes the situation and suggests recommendations to improve seat belt use in Lebanon. Design: Nine observational studies had been conducted in Lebanon during the last two decades between 1997 and 2017, and one qualitative study was performed in 2017. Results: The results show a significant variation in the use of the seat belt. When enforcement efforts are in progress, seat belt use increases. While when there are no checkpoints and the enforcement of seat belt use is almost absent, a significant fall was noticed. Discussion: The results of this study proved the failure of the Lebanese government in saving hundreds of lives just by a simple measure of enforcing seat belt law. Although experiences from various countries prove that such laws usually have a long-lasting effect on seat belt use, Lebanon failed to pursue the successful implementation of this law due to security and political problems. Conclusion: During the past two decades, Lebanon witnessed continuous fluctuations in seat belt use. Outside few short enforcement campaigns, our observations showed lack in seat belt use. Our observations of seat belt use among drivers and front seat passengers showed a significant correlation between seat belt use and the enforcement of seat belt law. The greatest national benefits from seat belt use are obtained when wearing rates are very high. This can be achieved only through a sustained enforcement campaign alongside other seat belt wearing interventions such as publicity and education. © 2019 Open Public Health Journal. All rights reserved.

Background Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. Findings Between 1995 and 2016, health spending grew at a rate of 4.00% (95% uncertainty interval 3.89-4.12) annually, although it grew slower in per capita terms (2.72% [2.61-2.84]) and increased by less than $ 1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5.55% [5.18-5.95]), mainly due to growth in government health spending, and in lower-middle-income countries (3.71% [3.10-4.34]), mainly from DAH. Health spending globally reached $ 8.0 trillion (7.8-8.1) in 2016 (comprising 8.6% [8.4-8.7] of the global economy and $ 10.3 trillion [10.1-10.6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$ 5252 (5184-5319) in high-income countries, $ 491 (461-524) in upper-middle-income countries, $ 81 (74-89) in lower-middle-income countries, and $ 40 (38-43) in low-income countries. In 2016, 0.4% (0.3-0.4) of health spending globally was in low-income countries, despite these countries comprising 10.0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($ 9.5 billion, 24.3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6.27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($ 644.7 million in 2018). Globally, health spending is projected to increase to $ 15.0 trillion (14.0-16.0) by 2050 (reaching 9.4% [7.6-11.3] of the global economy and $ 21.3 trillion [19.8-23.1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1.84% (1.68-2.02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0.6% (0.6-0.7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15.7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130.2 (122.9-136.9) in 2016 and is projected to remain at similar levels in 2050 (125.9 [113.7-138.1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. Interpretation Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets.

Objective: Female genital mutilation (FGM) is a major women’s health problem and human right violation. FGM has several physical and psychological consequences. The focus of the current study is the extent of FGM, the association of demographic and economic factors with FGM and women’s beliefs and attitudes towards FGM in Egypt, Guinea, Mali and Sierra Leone. Methods: The study used national representative, cross-sectional, household sample surveys with large sample of women of reproductive age (15 – 49 years) from each country. Multi stage cluster sampling and face-to-face interviews were used. It was cross-sectional analysis, using DHS data. Cross tabulation, multivariate analyses and bar-diagram were used. Results: In Egypt 94%, in Guinea 97%, in Mali 89% and in Sierra Leone, 91%) women had genital mutilation. The majority of the respondents believe that FGM that FGM is socially acceptable and a religious obligation. Majority of the respondents believe that FGM helps to maintain virginity and that it leads to better marriage prospects and the prevention of adultery. Conclusions: The majority of women in the four countries argued in favor for the continuation of FGM. There is an inverse relationship between FGM and higher education and affluence. Proper policies and awareness generation among less educated and less affluent women in rural areas are warranted in an attempt to reduce FGM.