Search results for: health care capabilities

Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Priyanka Sharma, Manoj Jais, Poonam Gupta, Suraiya K. Ansari, Ravinder Kaur

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Introduction: As much as the Health Care is necessary for the population, so is the management of the Biomedical waste produced. Biomedical waste is a wide terminology used for the waste material produced during the diagnosis, treatment or immunization of human beings and animals, in research or in the production or testing of biological products. Biomedical waste management is a chain of processes from the point of generation of Biomedical waste to its final disposal in the correct and proper way, assigned for that particular type of waste. Any deviation from the said processes leads to improper disposal of Biomedical waste which itself is a major health hazard. Proper segregation of Biomedical waste is the key for Biomedical Waste management. Improper disposal of BMW can cause sharp injuries which may lead to HIV, Hepatitis-B virus, Hepatitis-C virus infections. Therefore, proper disposal of BMW is of upmost importance. Health care establishments segregate the Biomedical waste and dispose it as per the Biomedical waste management rules in India. Objectives: This study was done to observe the current trends of Biomedical waste generated in a tertiary care Hospital in Delhi. Methodology: Biomedical waste management rounds were conducted in the hospital wards. Relevant details were collected and analysed and sites with maximum Biomedical waste generation were identified. All the data was cross checked with the commons collection site. Results: The total amount of waste generated in the hospital during January 2014 till December 2014 was 6,39,547 kg, of which 70.5% was General (non-hazardous) waste and the rest 29.5% was BMW which consisted highly infectious waste (12.2%), disposable plastic waste (16.3%) and sharps (1%). The maximum quantity of Biomedical waste producing sites were Obstetrics and Gynaecology wards with a total Biomedical waste production of 45.8%, followed by Paediatrics, Surgery and Medicine wards with 21.2 %, 4.6% and 4.3% respectively. The maximum average Biomedical waste generated was by Obstetrics and Gynaecology ward with 0.7 kg/bed/day, followed by Paediatrics, Surgery and Medicine wards with 0.29, 0.28 and 0.18 kg/bed/day respectively. Conclusions: Hospitals should pay attention to the sites which produce a large amount of BMW to avoid improper segregation of Biomedical waste. Also, induction and refresher training Program of Biomedical waste management should be conducted to avoid improper management of Biomedical waste. Healthcare workers should be made aware of risks of poor Biomedical waste management.

Keywords: biomedical waste, biomedical waste management, hospital-tertiary care, New Delhi

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Authors: Mariia Karizhenskaia, Tanvi Nandani, Ali Tafazoli Moghadam

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Hospice palliative care (HPC) is one of the most complicated philosophies of care in which physical, social/cultural, and spiritual aspects of human life are intermingled with an undeniably significant role in every aspect. Among these dimensions of care, culture possesses an outstanding position in the process and goal determination of HPC. This study shows the importance of cultural elements in the establishment of effective and optimized structures of HPC in the Canadian healthcare environment. Our systematic search included Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 1998 to 2023 to identify recent national literature connecting culture and palliative care delivery. The most frequently presented feature among the articles is the role of culture in the efficiency of the HPC. It has been shown frequently that including the culturespecific parameters of each nation in this system of care is vital for its success. On the other hand, ignorance about the exclusive cultural trends in a specific location has been accompanied by significant failure rates. Accordingly, implementing a culture-wise adaptable approach is mandatory for multicultural societies. The following outcome of research studies in this field underscores the importance of culture-oriented education for healthcare staff. Thus, all the practitioners involved in HPC will recognize the importance of traditions, religions, and social habits for processing the care requirements. Cultural competency training is a telling sample of the establishment of this strategy in health care that has come to the aid of HPC in recent years. Another complexity of the culturized HPC nowadays is the long-standing issue of racialization. Systematic and subconscious deprivation of minorities has always been an adversity of advanced levels of care. The last part of the constellation of our research outcomes is comprised of the ethical considerations of culturally driven HPC. This part is the most sophisticated aspect of our topic because almost all the analyses, arguments, and justifications are subjective. While there was no standard measure for ethical elements in clinical studies with palliative interventions, many research teams endorsed applying ethical principles for all the involved patients. Notably, interpretations and projections of ethics differ in varying cultural backgrounds. Therefore, healthcare providers should always be aware of the most respectable methodologies of HPC on a case-by-case basis. Cultural training programs have been utilized as one of the main tactics to improve the ability of healthcare providers to address the cultural needs and preferences of diverse patients and families. In this way, most of the involved health care practitioners will be equipped with cultural competence. Considerations for ethical and racial specifications of the clients of this service will boost the effectiveness and fruitfulness of the HPC. Canadian society is a colorful compilation of multiple nationalities; accordingly, healthcare clients are diverse, and this divergence is also translated into HPC patients. This fact justifies the importance of studying all the cultural aspects of HPC to provide optimal care on this enormous land.

Keywords: cultural competence, end-of-life care, hospice, palliative care

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Authors: Rehan Ullah

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The primary purpose of the study is to observe the relationship that exists between the organizational information technology (IT) capabilities and the organizational performance in China and Pakistan. Nations like China and Pakistan utilize modern techno-how to enhance their production endeavors. Therefore, making a wide-ranging comparison of the manufacturing services between China and Pakistan was chosen due to numerous reasons. One reason for carrying out this comparison is to determine how IT of the two countries enhances organizational competency on small and medium-sized manufacturing enterprises (SMEs). The study hypothesized that organizational IT capabilities (IT infrastructure, IT competence) have a positive influence on organizational performance and the strategic benefits of IT have a mediating effect on the relationship between IT capability and organizational performance. To investigate the relationship between IT capabilities and organizational performance, surveys were sent to managers of small, medium-sized manufacturing organizations located in the southwestern region, Sichuan province of China, and Pakistani companies, which are located in Islamabad, Lahore, and Karachi. These cities were selected as typical representatives of each country. Organizational performance has been measured in terms of profitability, organizational success, growth, market share, and innovativeness. Out of 400 surveys distributed to different manufacturing organizations, 303 usable and valid responses were received that are analyzed in this research. The data were examined using SPSS and Smart PLS computer software. The results of the study, including the descriptive statistics of each variable, are used. The outer model has been measured with considerations to content validity, discriminant validity, and convergent validity. The path coefficients among the constructs were also computed when analyzing the structural model using the bootstrapping technique. The analysis of data from both China and Pakistan yields an identical but unique result. The results show that IT infrastructure, IT competence, strategic benefits of IT are all correlated to the performance of the organizations. Moreover, strategic benefits of IT have been proved to mediate the relationship between IT capabilities and organization performance. The author, concerning the role of IT on the performance of an organization, highlights the different aspects as well as its benefits in an organization. The overall study concludes several implications for both managers and academicians. It also provides the limitations of the study and offers recommendations for future studies and practice.

Keywords: organizational performance, IT capabilities, IT infrastructure, IT competence, strategic benefits of IT, China, Pakistan

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Authors: Surendra Kumar Patel

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Disability is not just a health problem; it is a complex phenomenon, reflecting the interaction between features of a person’s age and physiology. Population ageing is a major demographic issue for India in the 21st century. Older population of India constituted 8% of total population, while 5.19% has affected by disability of older age group. Objective of the present research paper is to examine the state wise differential in disability among 60+ population and to access the health care of disabled population especially the 60+ disabled persons. The data sources of the present paper are census 2001 and 2011. For analyzing the state wise differentials by disability types and comparative advantage of data, rate, ratio, and percentage have been used. The Standardized Index of Diversity of Disability (SIDD) studies differential and diversity in disability. The results show that there are 5.19% persons have disability among 60+ population and sex differential not very significant, as it is 5.3 % of male and 5.05% in female in India but place of residence shows significant variation from 2001 to 2011 census. There is huge diversity in disability prevalence among 60+ in India, highest in Sikkim followed by Rajasthan, approximately, they comprise 11%, and the lowest found in Tamil Nadu as 2.53%. This huge gap in prevalence percentage shows the health care needs of highly prevailing states.

Keywords: disability, Standardized Index of Diversity of Disability (SIDD), differential and diversity in disability, 60+ population

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Authors: Kenechukwu Ikebuaku

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Entrepreneurship has long been offered as the panacea for poor economic growth and high rate of unemployment. Business incubation is considered an effective means for enhancing entrepreneurial actitivities while engendering socio-economic development. Information Technology Developers Entrepreneurship Accelerator (iDEA), is a software business incubation programme established by the Nigerian government as a means of boosting digital entrepreneurship activities and reducing unemployment in the country. This study assessed the contribution of iDEA Nigeria’s entrepreneurship programmes towards enhancing the capabilities of its tenants. Using the capability approach and the sustainable livelihoods approach, the study analysed iDEA programmes’ contribution towards the expansion of participants’ entrepreneurial capabilities. Apart from identifying a set of entrepreneurial capabilities from both the literature and empirical analysis, the study went further to ascertain how iDEA incubation has helped to enhance those capabilities for its tenants. It also examined digital entrepreneurship as a valued functioning and as an intermediate functioning leading to other valuable functioning. Furthermore, the study examined gender as a conversion factor in digital entrepreneurship. Both qualitative and quantitative research methods were used for the study, and measurement of key variables was made. While the entire population was utilised to collect data for the quantitative research, purposive sampling was used to select respondents for semi-structured interviews in the qualitative research. However, only 40 beneficiaries agreed to take part in the survey while 10 respondents were interviewed for the study. Responses collected from questionnaires administered were subjected to statistical analysis using SPSS. The study developed indexes to measure the perception of the respondents, on how iDEA programmes have enhanced their entrepreneurial capabilities. The Capabilities Enhancement Perception Index (CEPI) computed indicated that the respondents believed that iDEA programmes enhanced their entrepreneurial capabilities. While access to power supply and reliable internet have the highest positive deviations around mean, negotiation skills and access to customers/clients have the highest negative deviation. These were well supported by the findings of the qualitative analysis in which the participants unequivocally narrated how the resources provided by iDEA aid them in their entrepreneurial endeavours. It was also found that iDEA programmes have a significant effect on the tenants’ access to networking opportunities, both with other emerging entrepreneurs and established entrepreneurs. While assessing gender as a conversion factor, it was discovered that there was very low female participation within the digital entrepreneurship ecosystem. The root cause of this gender disparity was found in unquestioned cultural beliefs and social norms which relegate women to a subservient position and household duties. The findings also showed that many of the entrepreneurs could be considered opportunity-based entrepreneurs rather than necessity entrepreneurs, and that digital entrepreneurship is a valued functioning for iDEA tenants. With regards to challenges facing digital entrepreneurship in Nigeria, infrastructural/institutional inadequacies, lack of funding opportunities, and unfavourable government policies, were considered inimical to entrepreneurial capabilities in the country.

Keywords: entrepreneurial capabilities, unemployment, business incubators, development

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Authors: B. Nair, S. Singh

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Oral health behaviors such as dietary preferences and tooth brushing are acquired during a child’s primary socialization period yet many oral health promotion interventions are implemented without taking into account the role and impact of parental influence in supporting healthy oral health behaviors. The aim and objective of this study was to determine the relationship between parental income and level of education with knowledge, attitudes and perceptions of oral health care practices. Methods: The study design was cross-sectional and exploratory, and data collection occurred in two phases. Phase 1 comprised of a self-administered questionnaire. The sample consisted of parents of 313 Grade 1 learners aged between 5-6 years old attending one of twelve selected public primary schools in the Chatsworth Circuit, Durban, South Africa. Phase 2 comprised of focus group discussions held at 5 purposively selected schools. Data collection comprised of a semi-structured face-to-face group interview with the objective of obtaining a deeper understanding of parental knowledge, attitudes and perceptions of dental caries. Results and Discussion: Almost 56% of participants earned a monthly income of less than R6000 (600 US dollars). Nearly three quarters (77.5%) of participants indicated that they did not have medical aid/insurance scheme. More than three-quarters of the participants (76.6%) identified diet as being the primary cause of decayed teeth. More than half of the study sample (56.1%) indicated that milk teeth were important and that rotten teeth (74.6%) could affect the child’s health. Almost half (49.8%) of participants reported that “bad teeth” were inherited. With more than two-thirds of the participants (77.7%), having at most a high school education, there was a correlation between the level of the caregiver’s education and the oral health care of the child. The analysis of the correlation between a child having decayed teeth and income (p=.007); and the manner in which the income is received (p=.003) was statistically significant. The results indicate that more effort needs to be placed in understanding parental knowledge, perceptions and attitudes towards dental caries. Parental level of education, income and oral health literacy is shown to be related to attitudes, and perceptions towards dental caries and its subsequent preventive measures. These findings have important implications for oral health planning at community and facility-based levels.

Keywords: oral health prevention, parental education, dental caries, attitudes and perceptions

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Authors: Cherrie Lowe

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The TrendCare Patient Dependency System is currently utilized by a large number of Maternity Services across Australia, New Zealand and Singapore. In 2012, 2013, and 2014 validation studies were initiated in all three countries to validate the acuity tools used for Women in Labour, and Postnatal Mothers and Babies. This paper will present the findings of the validation study. Aim: The aim of this study was to; Identify if the care hours provided by the TrendCare Acuity System was an accurate reflection of the care required by Women and Babies. Obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of Maternity care models in three countries. Method: A non-experimental action research methodology was used across four District Health Boards in New Zealand, two large public Australian Maternity services and a large tertiary Maternity service in Singapore. Standardized data collection forms and timing devices were used to collect Midwife contact times with Women and Babies included in the study. Rejection processes excluded samples where care was not completed/rationed. The variances between actual timed Midwife/Mother/Baby contact and actual Trend Care acuity times were identified and investigated. Results: 87.5% (18) of TrendCare acuity category timings matched the actual timings recorded for Midwifery care. 12.5% (3) of TrendCare night duty categories provided less minutes of care than the actual timings. 100% of Labour Ward TrendCare categories matched actual timings for Midwifery care. The actual times given for assistance to New Zealand independent Midwives in Labour Ward showed a significant deviation to previous studies demonstrating the need for additional time allocations in Trend Care. Conclusion: The results demonstrated the importance of regularly validating the Trend Care category timings with the care hours required, as variances to models of care and length of stay in Maternity units have increased Midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the Independent Midwife has increased substantially. Outcomes: As a consequence of this study changes were made to the night duty TrendCare Maternity categories, additional acuity indicators developed and times for assisting independent Midwives increased. The updated TrendCare version was delivered to Maternity services in 2014.

Keywords: maternity, acuity, research, nursing workloads

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Authors: Upasana Sharma, Jayanti Dutta, Amarjeet Singh

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Background: Ayurveda is a comprehensive natural health care system. It is widely used in India as a system of primary health care, and interest in it is growing worldwide. Objectives: 1) To assess the extent and pattern of use of Ayurvedic medicines/ products by the people of Chandigarh. 2) To assess the perceived impact of use of Ayurvedic medicines/ products among the users. Methods: A cross-sectional community based study was conducted in a city of North India. Overall 371 households were covered from rural, urban and slum areas from December 2010 to April 2011. Respondents were interviewed regarding practices about Ayurveda products. Results: Around 160 (43%; 95% CI= 38.15, 47.85) of the respondents were using Ayurvedic products in one form or the other. Out of them, 91 (57%) had used Ayurvedic medicines in combination with some other system of medicine rather than as a standalone therapy. Most of them (81%) preferred Ayurveda products for chronic digestive system related problems. Conclusion: The present study revealed that respondents had keen interest in Ayurveda. A section of population was taking Ayurvedic treatment for their health ailments. There was a great level of satisfaction among the users but high cost bothered them at times.

Keywords: ayurveda, alternative medicine, chronic diseases, complimentary medicine

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Authors: Evelyn Fabian

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The focus of this discussion centres on the emerging issues in Early Childhood Care and development in Nigeria. Early childhood care is the bedrock of Nigeria’s educational system. However, there are critical issues that had not been addressed and it is frustrating the entire educational process. Thus, this paper will show the inter-connectedness between these issues such as poor funding, trained skillful teachers that would supervise the learning process of the kids, unconducive learning environment and lack of relevant facilities. For a clear grasp of these issues, the researcher visited 36 early childhood centres distributed across the 36 spates of Nigeria. The findings which were expressed in simple percentages revealed a near total absence or government neglect of these critical areas. The findings equally showed a misplaced priority in the government allocation of funds to early child care education and development. The study concludes that this mismatch in the training of these categories of pupils, government should expedite action in addressing these emerging issues in early childhood care and development in Nigeria.

Keywords: early childhood, ECCE, education, emerging issues

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Authors: Shivaram P. Arunachalam, Mustafa Y. Sir, Andy Boggust, David M. Nestler, Thomas R. Hellmich, Kalyan S. Pasupathy

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Emergency departments (EDs) provide urgent care to patients throughout the day in a complex and chaotic environment. Real-time location systems (RTLS) are increasingly being utilized in healthcare settings, and have shown to improve safety, reduce cost, and increase patient satisfaction. Radio Frequency Identification Device (RFID) data in an ED has been shown to compute variables such as patient-provider contact time, which is associated with patient outcomes such as 30-day hospitalization. These variables can provide avenues for improving ED operational efficiency. A major challenge with ED financial operations is under-coding of critical care services due to physicians’ difficulty reporting accurate times for critical care provided under Current Procedural Terminology (CPT) codes 99291 and 99292. In this work, the authors propose a framework to optimize ED critical care billing using RFID data. RFID estimated physician-patient contact times could accurately quantify direct critical care services which will help model a data-driven approach for ED critical care billing. This paper will describe the framework and provide insights into opportunities to prevent under coding as well as over coding to avoid insurance audits. Future work will focus on data analytics to demonstrate the feasibility of the framework described.

Keywords: critical care billing, CPT codes, emergency department, RFID

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Authors: Shannon Hearney, Jeffrey Hoch

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Pancreatic cancer is a notoriously costly and deadly form of cancer. Many types of treatment centers exist for patients to seek care from, including high-volume centers which have shown promise to provide the highest quality of care. While it may be true that this type of center provides the best care it is unclear if that care is cost-effective. Studies in the US have confirmed that high-volume hospitals do provide higher quality of care but have shown inconsistencies in the cost-effectiveness of that care. Other studies, like those from Finland have shown that high-volume centers had lower mortality and lower costs than low-volume centers. This paper thus seeks to review the current scientific literature to better understand if high-volume centers are cost-effective in delivering care in both a European setting and in the US. A review of major reference databases such as Medline, Embase and PubMed will be conducted for cost-effectiveness studies on the surgical treatment of pancreatic cancer at high-volume centers. Possible MeSH terms to be included, but not limited to, are: “pancreatic cancer”, “cost analysis”, “cost-effectiveness”, “economic evaluation”, “pancreatic neoplasms”, “surgical”, and “high-volume”. Studies must also have been available in the English language. This review will encompass European scientific literature, as well as those in the US. Based on our preliminary findings, we anticipate high-volume hospitals to provide better care at greater costs. We anticipate that high-volume hospitals may be cost-effective in different contexts depending on the national structure of a healthcare system. Countries with more centralized and socialized healthcare may yield results that are more cost-effective. High-volume centers may differ in their cost-effectiveness of the surgical care of pancreatic cancer internationally especially when comparing those in the United States to others throughout Europe.

Keywords: cost-effectiveness analysis, economic evaluation, pancreatic cancer, scientific literature review

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Authors: Ellen Dahl Gundersen, Berit Johannessen

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Introduction: Dementia and depression are common mental disorders of nursing home residents. The care of these residents consists of providing both physical, social and mental care. Too often, the physical needs are given priority, and municipal health services are urged to focus more on the patients mental and social needs. The presence of dogs may have positive impact on the mental health of nursing home residents by improving mood, social interaction and enjoyment of the visits. The voluntary organization Red Cross, has given priority to this subject by training and certifying dogs and owners (equipages), committed for regular visits at local nursing homes. Focus of this study: How do the dog owners and employees experience the presence of a dog equipage concerning the mental health of nursing home residents? Method: Individual interviews with 8-10 certified dog owners who are volunteers from Red Cross, contributing with regular visits at local nursing homes. Focus group interviews with 10 employees working in two different nursing homes. Preliminary results: Five to seven residents and one or two employees attended weekly dog equipage visits during a period of six months. The presence of an equipage seems to have made the residents calm and more social orientated with a lighter mood and better verbal expression. Some of the residents with dementia remembered the name of the dog from one week to another. The informants also reported positive outcome for the residents by their opportunity to give and get close through physical contact with a dog. Further, the presence of an equipage affected the atmosphere at the nursing home positively by promoting joy and initiating conversations about dogs. A conscious approach by the dog owners towards the residents seems to be of significance to this matter. The positive attitude and support from employees also seem to be of crucial importance for the maintenance of these visits. Conclusion: The presence of trained dog equipages in nursing homes seems to have had an overall positive impact on the mental health of residents. A conscious approach from the dog owners as well as positive support from employees seems to have a crucial impact on the success and maintenance of the visits. These findings correspond well to former research and can thereby give implications for more extended use of dogs as a mental health promoting initiative towards geriatric consumers of municipal health care services. Further research through larger studies is needed.

Keywords: animal assisted intervention, geriatric mental health, nursing home, resident

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Authors: Sisay Tiroro Salato

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Background: Ethiopia has been implementing the maternal death surveillance and response system to provide real-time actionable information, including causes of death and contributing factors. Analysis of maternal mortality surveillance data was conducted to identify the causes and underlying factors in Addis Ababa, Ethiopia. Methods: We carried out a retrospective surveillance data analysis of 324 maternal deaths reported in Addis Ababa, Ethiopia, from 2017 to 2021. The data were extracted from the national maternal death surveillance and response database, including information from case investigation, verbal autopsy, and facility extraction forms. The data were analyzed by computing frequency and presented in numbers, proportions, and ratios. Results: Of 324 maternal deaths, 92% died in the health facilities, 6.2% in transit, and 1.5% at home. The mean age at death was 28 years, ranging from 17 to 45. The maternal mortality ratio per 100,000 live births was 77for the five years, ranging from 126 in 2017 to 21 in 2021. The direct and indirect causes of death were responsible for 87% and 13%, respectively. The direct causes included obstetric haemorrhage, hypertensive disorders in pregnancy, puerperal sepsis, embolism, obstructed labour, and abortion. The third delay (delay in receiving care after reaching health facilities) accounted for 57% of deaths, while the first delay (delay in deciding to seek health care) and the second delay (delay in reaching health facilities) and accounted for 34% and 24%, respectively. Late arrival to the referral facility, delayed management after admission, andnon-recognition of danger signs were underlying factors. Conclusion: Over 86% of maternal deaths were attributed by avoidable direct causes. The majority of women do try to reach health services when an emergency occurs, but the third delays present a major problem. Improving the quality of care at the healthcare facility level will help to reduce maternal death.

Keywords: maternal death, surveillance, delays, factors

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Authors: A. Gonzalez Aguna, J. M. Santamaria Garcia, J. L. Gomez Gonzalez, R. Barchino Plata, M. Fernandez Batalla, S. Herrero Jaen

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Background: Computer Science is a field that transcends other disciplines of knowledge because it allows to support all kinds of physical and mental tasks. Health centres have a greater number and complexity of technological devices and the population consume and demand services derived from technology. Also, nursing education plans have included competencies related to and, even, courses about new technologies are offered to health professionals. However, nurses still limit their performance to the use and evaluation of products previously built. Objective: Develop a teaching-learning methodology for acquiring skills on designing applications for care. Methodology: Blended learning teaching with a group of graduate nurses through official training within a Master's Degree. The study sample was selected by intentional sampling without exclusion criteria. The study covers from 2015 to 2017. The teaching sessions included a four-hour face-to-face class and between one and three tutorials. The assessment was carried out by written test consisting of the preparation of an IEEE 830 Standard Specification document where the subject chosen by the student had to be a problem in the area of care. Results: The sample is made up of 30 students: 10 men and 20 women. Nine students had a degree in nursing, 20 diploma in nursing and one had a degree in Computer Engineering. Two students had a degree in nursing specialty through residence and two in equivalent recognition by exceptional way. Except for the engineer, no subject had previously received training in this regard. All the sample enrolled in the course received the classroom teaching session, had access to the teaching material through a virtual area and maintained at least one tutoring. The maximum of tutorials were three with an hour in total. Among the material available for consultation was an example of a document drawn up based on the IEEE Standard with an issue not related to care. The test to measure competence was completed by the whole group and evaluated by a multidisciplinary teaching team of two computer engineers and two nurses. Engineers evaluated the correctness of the characteristics of the document and the degree of comprehension in the elaboration of the problem and solution elaborated nurses assessed the relevance of the chosen problem statement, the foundation, originality and correctness of the proposed solution and the validity of the application for clinical practice in care. The results were of an average grade of 8.1 over 10 points, a range between 6 and 10. The selected topic barely coincided among the students. Examples of care areas selected are care plans, family and community health, delivery care, administration and even robotics for care. Conclusion: The applied methodology of learning-teaching for the design of technologies demonstrates the success in the training of nursing professionals. The role of expert is essential to create applications that satisfy the needs of end users. Nursing has the possibility, the competence and the duty to participate in the process of construction of technological tools that are going to impact in care of people, family and community.

Keywords: care, learning, nursing, technology

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Authors: Eeva Wallenius-Nareneva, Tuula Toivanen-Labiad

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Background: Oral health promotion event was organised for forty Afghanistan, Iraqi and Bangladeshi underage asylum seekers in Finland. The invitation to arrange this coaching occasion was accepted in the Degree Programme in Oral Hygiene in Metropolia. The personnel in the reception center found the need to improve oral health among the youngsters. The purpose was to strengthen the health literacy of the boys in their oral self-care and to reduce dental fears. The Finnish studies, especially the terminology of oral health was integrated to coaching with the help of interpreters. Cooperative learning was applied. Methods: Oral health was interactively discussed in four study group sessions: 1. The importance of healthy eating habits; - Good and bad diets, - Regular meals, - Acid attack o Xylitol. 2. Oral diseases − connection to general health; - Aetiology of gingivitis, periodontitis and caries, - Harmfulness of smoking 3. Tools and techniques for oral self-care; - Brushing and inter dental cleaning. 4. Sharing earlier dental care experiences; - Cultural differences, - Dental fear, - Regular check-ups. Results: During coaching deficiencies appeared in brushing and inter dental cleaning techniques. Some boys were used to wash their mouth with salt justifying it by salt’s antiseptic properties. Many brushed their teeth by vertical movements. The boys took feedback positively when a demonstration with model jaws revealed the inefficiency of the technique. The advantages of fluoride tooth paste were advised. Dental care procedures were new and frightening for many boys. Finnish dental care system was clarified. The safety and indolence of the treatments and informed consent were highlighted. Video presentations and the dialog lowered substantially the threshold to visit dental clinic. The occasion gave the students means for meeting patients from different cultural and language backgrounds. The information hidden behind the oral health problems of the asylum seekers was valuable. Conclusions: Learning dental care practices used in different cultures is essential for dental professionals. The project was a good start towards multicultural oral health care. More experiences are needed before graduation. Health education themes should be held simple regardless of the target group. The heterogeneity of the group does not pose a problem. Open discussion with questions leading to the theme works well in clarifying the target group’s knowledge level. Sharing own experiences strengthens the sense of equality among the participants and encourages them to express own opinions. Motivational interview method turned out to be successful. In the future coaching occasions must confirm active participation of everyone. This could be realized by dividing the participants to even smaller groups. The different languages impose challenges but they can be solved by using more interpreters. Their presence ensures that everyone understands the issues properly although the use of plain and sign languages are helpful. In further development, it would be crucial to arrange a rehearsal occasion to the same participants in two/three months’ time. This would strengthen the adaption of self-care practices and give the youngsters opportunity to pose more open questions. The students would gain valuable feedback regarding the effectiveness of their work.

Keywords: cooperative learning, interactive methods, motivational interviewing, oral health promotion, underage asylum seekers

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Authors: Ojochenemi J. Onubi, Debbi Marais, Lorna Aucott, Friday Okonofua, Amudha Poobalan

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Background: Obesity is a worldwide epidemic with major health and economic consequences. Pregnancy is a trigger point for the development of obesity, and maternal obesity is associated with significant adverse effects in the mother and child. Nigeria is experiencing a double burden of under- and over-nutrition with rising levels of obesity particularly in women. However, there is scarcity of data on maternal obesity in Nigeria and other African countries. Aims and Objectives: This project aimed at identifying crucial components of potential interventions for maternal obesity in Nigeria. The objectives were to assess the prevalence, effects, and distribution of maternal obesity; knowledge, attitude and practice (KAP) of pregnant women and maternal healthcare providers; and identify existing interventions for maternal obesity in Nigeria. Methodology: A systematic review and meta-analysis were initially conducted to appraise the existing literature on maternal obesity in Africa. Following this, a quantitative questionnaire survey of the KAP of pregnant women and a qualitative interview study of the KAP of Health Care Workers (HCW) were conducted in seven secondary and tertiary hospitals across Nigeria. Quantitative data was analysed using SPSS statistical software, while thematic analysis was conducted for qualitative data. Results: Twenty-nine studies included in the systematic review showed significant prevalence, socio-demographic associations, and adverse effects of maternal obesity on labour, maternal, and child outcomes in Africa. The questionnaire survey of 435 mothers revealed a maternal obesity prevalence of 17.9% among mothers who registered for antenatal care in the first trimester. The mothers received nutrition information from different sources and had insufficient knowledge of their own weight category or recommended Gestational Weight Gain (GWG), causes, complications, and safe ways to manage maternal obesity. However, majority of the mothers were of the opinion that excess GWG is avoided in pregnancy and some practiced weight management (diet and exercise) during pregnancy. For the qualitative study, four main themes were identified: ‘Concerns about obesity in pregnancy’, ‘Barriers to care for obese pregnant women’, ‘Practice of care for obese pregnant women’, and ‘Improving care for obese pregnant women’. HCW expressed concerns about rising levels of maternal obesity, lack of guidelines for the management of obese pregnant women and worries about unintended consequences of antenatal interventions. ‘Barriers’ included lack of contact with obese women before pregnancy, late registration for antenatal care, and perceived maternal barriers such as socio-cultural beliefs of mothers and poverty. ‘Practice’ included anticipatory care and screening for possible complications, general nutrition education during antenatal care and interdisciplinary care for mothers with complications. HCW offered suggestions on improving care for obese women including timing, type, and settings of interventions; and the need for involvement of other stake holders in caring for obese pregnant women. Conclusions: Culturally adaptable/sensitive interventions should be developed for the management of obese pregnant women in Africa. Education and training of mothers and health care workers, and provision of guidelines are some of the components of potential interventions in Nigeria.

Keywords: Africa, maternal, obesity, pregnancy

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Authors: Ioana G. Turcan

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reimagined rituals towards unattachment wants to look at an ambiguous loss through the perspective of caregivers, those that accompany us at the beginning and possibly the end of life, those that observe, accumulate, and are impacted by our behavior and needs, but also those that are the witnesses of the human vulnerability. Someone taking care of a patient with dementia experiences ambiguous loss, being in a present of a person partially present, partially absent. The one offering care needs care, not isolation and the aim of the project is to consolidate existing communities or engage other possible ones using performance, storytelling, and other artistic methods. The long-term aim is that with community work, we will manage to co-create rituals in order to help us live with this kind of loss. Looking at them through the lens of different cultures and individuals exercises both the ability to extract the universal essence of a ritual, but also the need and freedom to express the specificity of each situation. To be seen and acknowledged by others, but more importantly, to see oneself from outside with dignity, is very powerful. Oftentimes we forget to express, look and appreciate our own stories, and instead, we choose to outcast them.

Keywords: grief, socio-politics of loss, ambiguous loss, rituals

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Authors: Hala Kama Ahmed Rashwan

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Ensuring the patient safety especially at intensive care units and those exposed to hospital tools and equipment is one of the most important challenges facing healthcare today. Outbreak of food poisoning as a result of food-borne pathogens has been reported in many hospitals and care homes all over the world due to hospital meals. Patient safety of eating hospital meals is a fundamental principle of healthcare; it is new healthcare disciplines that assure the food raw materials, food storage, meals processing, and control of kitchen errors that often lead to adverse healthcare events. The aim of this article is to promote any hospital in attaining the hygienic practices and better quality system during processing of the ready-to- eat meals for intensive care units patients according to the WHO safety guidelines.

Keywords: hospitals, meals, safety, intensive care

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Authors: Seyed Habib A. Rahmati, Mohamad Hasan Sadeghpour, Parsa Fallah Sheikhlari

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Location quotient (LQ) is a comparison technique that represents emphasized economic structure of single zone versus the standard area to identify specialty for every zone. In another words, the exact calculation of this metric can show the main core competencies and critical capabilities of an area to the decision makers. This research focus on the exact calculation of the LQ for an Iranian Province called Qazvin and within a case study introduces LQ of the capable industries of Qazvin. Finally, through different graphs and tables, it creates an opportunity to compare the recognized capabilities.

Keywords: location quotient, case study, province analysis, core competency

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Authors: Ali Rabiee, Hessam Ghasemnejad

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Extensive experimental investigation on the effect of stitching pattern on tubular composite structures was conducted. The effect of stitching reinforcement through thickness on using glass flux yarn on energy absorption of fiber-reinforced polymer (FRP) was investigated under high speed loading conditions at axial loading. Keeping the mass of the structure at 125 grams and applying different pattern of stitching at various locations in theory enables better energy absorption, and also enables the control over the behaviour of force-crush distance curve. The study consists of simple non-stitch absorber comparison with single and multi-location stitching behaviour and its effect on energy absorption capabilities. The locations of reinforcements are 10 mm, 20 mm, 30 mm, 10-20 mm, 10-30 mm, 20-30 mm, 10-20-30 mm and 10-15-20-25-30-35 mm from the top of the specimen. The effect of through the thickness reinforcements has shown increase in energy absorption capabilities and crushing load. The significance of this is that as the stitching locations are closer, the crushing load increases and consequently energy absorption capabilities are also increased. The implementation of this idea would improve the mean force by applying stitching and controlling the behaviour of force-crush distance curve.

Keywords: through-thickness stitching, 3D enforcement​, energy absorption, tubular composite structures

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Authors: Khaliun Nyambayar, Nomindari Azzaya, Batkhuyag Purevjav

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Pharmacovigilance was officially introduced in Mongolia in 2003, in accordance with the Health Minister Order 183 for the registry of adverse drug reactions (ADR), approved in 2006 and was reviewed in 2010. This study was designed to evaluate the incidence and common types of adverse drug reactions among hospitalized children, the frequency of adverse drug reaction reported by health care providers, and the follow-up processes resulting from adverse drug reactions. A retrospective study of paediatric patients who experienced an adverse drug reaction from 2015 to 2019, extracted from the “yellow” card at the State Research Center for Maternal and Child Health, (city). A total of 417 adverse drug reactions were reported with an overall incidence was 80 (21.5%). Adverse reactions resulting from the use of antibiotics (particularly gentamycin, cephalosporins, and vancomycin) were usually mild. ADR’s were reported by physicians and nurses (93.8%), pharmacists (6.25%). Although documentation of physician notification occurred for 93% of adverse drug reactions, only 29% of cases were documented in the patient's medical chart, 13% included follow-up education for individuals involved, and 10% were updated in the allergy profile of the hospital computer system. Measures to improve the detection and reporting of adverse drug reactions by all health care professionals should be improved, to enhance our understanding of the nature and impact of these reactions in children.

Keywords: adverse drug reaction, pediatric, yellow card, Mongolia

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Authors: Chen-Yuan Hsu

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Introduction Elderly is growing and results to live in the long-term care (LTC) and then due to the routine of the facilities in Taiwan, also resulted to losing of those people with environment interaction, so, the self-reliance support (SRS) for those people to experience environment interaction is an essential. Methods This study was recruited samples of a LTC in the central of Taiwan. There was a following research on the SRS group with 20 samples collected and routine care group with 20 samples. A structured questionnaire as the Environment Interaction Dimension, as data collection included demographic information and the dimensions of environment interaction. Data analysis used SPSS 22.0 for Window 2000 to report the finding. Results The Environment Interaction Dimension for Taiwanese is a Chinese version of the containing 8 items. The result of t-test analysis found that environment interaction showed a significant difference between groups (p＜.05), the result recommended that there was a higher score of environment interaction dimension on the SRS group (29.90±5.56) comparing with the routine care group (22.1±5.53). Conclusion This study showed that the SRS group was higher than the routine care group on the environment interaction dimension for Taiwanese elderly living in the LTC. The results can also provide the reference for LTC, to encourage those people to participate in SRS in LTC, and therefore also improving their environment interaction.

Keywords: self-reliance support, environment interaction, long-term care, elderly

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Authors: Saeed Haghnia

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This paper traces the back history of environments in which the elderly who could not stay in private dwellings were accommodated and taken care of in Iran in the 19th century. It investigates the factors impacting on the establishment of the first nursing homes in Iran in 1973. Today in 2020, the nursing home is the only available model of residential care environment for the elderly who cannot stay in private dwellings in Iran. Understanding the evolution of these environments from a socio-political perspective is crucial before studying nursing homes’ response to the elderly and society in Iran and seeking any alternative model specific to the context. However, no study on the evolution of these environments in Iran was found. Thus, this paper, by going through primary and secondary resources and from a socio-political perspective, investigates how the elderly who could not stay in private dwellings were accommodated and taken care of in Iran in the 19th century. Maristan, in the early 19th century in Egypt as a part of Islamic territory, is an example of such spaces in which homeless elderly were kept and taken care of. This study suggests that in the 19th century in Iran in lack of significant governmental influence over people’s social affairs, any potential environments accommodating and taking care of the elderly who could not stay in private dwellings (mainly homeless) in Iran were probably regulated or supported by local figures, specifically clergies, as a response to the need for taking care of the vulnerable members of society.

Keywords: nursing home, ageing, Iran, middle east, Qajar, Pahlavi

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Authors: Su-Lin Yu

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This paper will explore how gender and care discourse are intersected, reformulated and contested in American daughters’ caregiving memoirs. In particular, it will attempt to show how gender structure has worked to regulate a daughter’s response to her mother’s illness. In other words, how do certain cultural notions and class difference affect the ways in which the daughter enacts her caregiving response to her mother’s illness? What is the interrelation of female subjectivity and care practice? To understand care and gender politics in the memoirs, this paper will engage in close readings of five texts: Sandra Bullock Simith’s Trading Places: Becoming My Mother’s Mother: A Daughter’s Memoir (2015),Martha Stettinius’s Inside the Dementia Epidemic: A Daughter’s Memoir (2012), Patricia Thompson Collamer’s Grace on the Ledge: a Caregiver's Memoir, Judith Henry’s The Dutiful Daughter's Guide to Caregiving: A Practical Memoir (2015), and The Daughter's Dilemma: A Survival Guide to Caring for an Aging, Abusive Parent by Emily Wanderer Cohen (2018). By analyzing these texts, this paper will show why adult daughters become the primary caregivers, how gender norms and care practices influence a daughter’s thoughts and actions, and how it affects her self-understanding. Taken as a whole, then, the paper will provide an important examination not only of care and gender politics, but also a contribution to the intersecting discourses of illness, death, and mother-daughter relationship.

Keywords: care ethics, daughter-mother relationship, gender politics, memoirs

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Authors: Yamam Abuzinadah

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Mental health literacy has become a very influential topic around the world due to the increase of mental health issues that have been reported through national research and surveys. Mental health literacy refers to the awareness, attitudes, beliefs, knowledge and skills when dealing with mental illness. This research explores mental health literacy in the Arabic and the ways culture informs perceptions of mental health in general. Also, the impact of mental health literacy on: help-seeking attitudes, relationships and community interactions. The outcomes of this research will contribute to raising mental health awareness among the Arabic community, develop and enhance mental health service provision and explore new ideas in regards to elevating mental health literacy in the Arabic community. This research aims to explore attitudes, beliefs, perspective, values and perceptions toward mental health in general among the Arabic community. It will also aim to highlight the factors contributing to theses beliefs, perspective, value and perception and accordingly the role these factors play in regards to awareness, services access, recovery and care provided from the family and the community. This thesis will aim to reflect a detailed theorisation and exploration of: (1) The impact of cultural factors on mental health literacy ie. attitudes, beliefs, knowledge and skills. (2) The ways culture informs perceptions of mental health literacy. (3) The impact of mental health literacy on: help-seeking behaviors, and relationships and community interactions.

Keywords: Arab, mental health, literacy, awareness

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Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

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Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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Authors: Rungnapa Chantra

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As health care rapidly changes, the nursing profession is also evolving to improve quality of care while maintaining competency in their practice. The purpose of this study was to investigate the factors of disaster nurse competencies and investigate the predictable variables in disaster nurse competencies in Suratthani Province, Thailand. The sample consisted of 305 nurses who were recruited by simple random sampling. The development questionnaires from ICN Framework and research contains Pre/Mitigation, Preparedness, Response and Recovery/Rehabilitation Competencies (α=0.87). The data were analyzed using Principle Components Extraction and Orthogonal Rotation with Varimax Method. The findings were as follows; four significant factors of disaster nurse competencies in Suratthani Province, Thailand were identified. These factors were described by 62 variables that accounted for 50.01% of the total variance. The results of this study could be for agencies that are responsible for the development of nursing competencies and should be aware of the development of knowledge and skills in disaster management.

Keywords: disaster nursing competency of nurses, nursing informatics, health science, medical

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Authors: Humaira Maheen, Elizabeth Hoban, Catherine Bennette

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Background: Globally, role of Community Health Workers (CHW) as front line disaster health work force is underutilized. Developing countries which are at risk of natural disasters or humanitarian emergencies should lay down effective strategies especially to ensure adequate access to maternity care during crisis situation by using CHW as they are local, trained, and most of them possess a good relationship with the community. The Minimum Initial Service Package (MISP) is a set of universal guidelines that addresses women’s reproductive health needs during the first phase of an emergency. According to the MISP, pregnant women should have access to a skilled birth attendant and adequate transportation arrangements so they can access a maternity care facility. Pakistan is one of the few countries which has been severely affected by a number of natural disaster as well as humanitarian emergencies in last decade. Pakistan has a young and structured National Disaster Management System in place, where District Authorities play a vital role in disaster management. The District Health Department develops the contingency health plan for an emergency situation and implements it under the existing district health human resources (health workers and medical staff at the health facility) and infrastructure (health care facilities). Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. The district health department didn’t make transportation arrangement for labouring women from relief camp to the nearest health care facility. As a result 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth. Of the 332 women who were pregnant at the time of the floods, 26 had adverse birth outcomes; 10 had miscarriages, 14 had stillbirths and there were four neonatal deaths. Conclusion: The district health department was not able to provide access to adequate maternity care during according to the international standard during the floods in 2011. We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps. Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. Nearly 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth, and the health camp was mostly accessed by men and always overcrowded. There was no obstetric trained medical staff in the health camps or transportation provided to take women with complications to the nearest health facility. The rate of adverse outcome following disaster was 22.2% (95% CI: 8.62% – 42.2%) amongst 27 women who did not evacuate as compare to 7.91% (95% CI: 5.03% – 11.8%) among 278 women who lived in relief camp study participants. There were 27 women who evacuated on pre-flood warning and had 0% rate of adverse outcome. Conclusion: We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps.

Keywords: natural disaster, maternity care model, rural, Pakistan, community health workers

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Authors: Pariya Sheykhmaleki, Debajyoti Pati

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Rural areas in the United States face numerous challenges in providing quality and assessable primary healthcare services, especially during emergencies such as natural disasters or pandemics. This study showcases a cutting-edge flexible module that aims to overcome these challenges by offering adaptable healthcare facilities capable of providing comprehensive health services in remote and disaster-prone regions. According to the Health Resources and Services Administration (HRSA), approximately 62 million Americans, or 1 in 5 individuals, live in areas designated as Health Professional Shortage Areas (HPSAs) for primary care. These areas are characterized by limited access to healthcare facilities, shortage of healthcare professionals, transportation barriers, inadequate healthcare infrastructure, higher rates of chronic diseases, mental health disparities, and limited availability of specialized care, including urgent circumstances like pandemics that can exacerbate this issue. To address these challenges, the literature study began by examining primary health solutions in very remote areas, e.g., spaceships, to identify the state-of-the-art technologies and the methods used to facilitate primary care needs. The literature study on flexibility in architecture and interior design was also adapted to develop a conceptual design for rural areas. The designed flexible module provides an innovative solution. This module can be prefabricated as all parts are standardized. The flexibility of the module allows the structure to be modified based on local and geographical requirements as well as the ability to expand as required. It has been designed to stand either by itself or work in tandem with public buildings. By utilizing sustainable approaches and flexible spatial configurations, the module optimizes the utilization of limited resources while ensuring efficient and effective healthcare delivery. Furthermore, the poster highlights the key features of this flexible module, including its ability to support telemedicine and telehealth services for all five levels of urgent care conditions, i.e., from facilitating fast tracks to supporting emergency room services, in two divided zones. The module's versatility enables its deployment in rural areas located far from urban centers and disaster-stricken regions, ensuring access to critical healthcare services in times of need. This module is also capable of responding in urban areas when the need for primary health becomes vastly urgent, e.g., during a pandemic. It emphasizes the module's potential to bridge the healthcare gap between rural and urban areas and mitigate the impact of rural health challenges.

Keywords: rural health, healthcare challenges, flexible modular design, telemedicine, telehealth

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