Search results for: comprehensive care

Authors: Yoseph Halala Handiso, Zewdi Gebregziabher

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Background: Malnutrition in hospitalized patients remains a major public health problem in both developed and developing countries. Despite the fact that malnourished patients are more prone to stay longer in hospital, there is limited data regarding the magnitude of malnutrition and its effect on length of stay among surgical patients in Ethiopia, while nutritional assessment is also often a neglected component of the health service practice. Objective: This study aimed to assess the prevalence of malnutrition at admission and its effect on the length of hospital stay among adult surgical patients in Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, 2022. Methods: A facility-based prospective cohort study was conducted among 398 adult surgical patients admitted to the hospital. Participants in the study were chosen using a convenient sampling technique. Subjective global assessment was used to determine the nutritional status of patients with a minimum stay of 24 hours within 48 hours after admission (SGA). Data were collected using the open data kit (ODK) version 2022.3.3 software, while Stata version 14.1 software was employed for statistical analysis. The Cox regression model was used to determine the effect of malnutrition on the length of hospital stay (LOS) after adjusting for several potential confounders taken at admission. Adjusted hazard ratio (HR) with a 95% confidence interval was used to show the effect of malnutrition. Results: The prevalence of hospital malnutrition at admission was 64.32% (95% CI: 59%-69%) according to the SGA classification. Adult surgical patients who were malnourished at admission had higher median LOS (12 days: 95% CI: 11-13) as compared to well-nourished patients (8 days: 95% CI: 8-9), means adult surgical patients who were malnourished at admission were at higher risk of reduced chance of discharge with improvement (prolonged LOS) (AHR: 0.37, 95% CI: 0.29-0.47) as compared to well-nourished patients. Presence of comorbidity (AHR: 0.68, 95% CI: 0.50-90), poly medication (AHR: 0.69, 95% CI: 0.55-0.86), and history of admission (AHR: 0.70, 95% CI: 0.55-0.87) within the previous five years were found to be the significant covariates of the length of hospital stay (LOS). Conclusion: The magnitude of hospital malnutrition at admission was found to be high. Malnourished patients at admission had a higher risk of prolonged length of hospital stay as compared to well-nourished patients. The presence of comorbidity, polymedication, and history of admission were found to be the significant covariates of LOS. All stakeholders should give attention to reducing the magnitude of malnutrition and its covariates to improve the burden of LOS.

Keywords: effect of malnutrition, length of hospital stay, surgical patients, Ethiopia

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Authors: Eudjen Cinc

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Common Byzantine origins of church music of Serbs and Romanians are certainly not the only reason for great similarities between the ways of singing of the two nations, especially in the region of Banat. If it was so, the differences between the interpretation of church music in this part of Orthodox religion and the one specific for other parts where Serbs or Romanians live could not be explained. What is it that connects church signing of two nations in this peaceful part of Europe to such an extent that it could be considered a comprehensive corpus, different from other 'Serbian' or 'Romanian' regions? This is the main issue dealt with in the text according to examples and comparative processing of material. The main aim of the paper is representation of the new and interesting, while its value lies in its potential to encourage the reader or a future researcher to investigate and search further.

Keywords: folk influences, melody, melodic models, ethnomusicology

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Authors: Faith O. Olanrewaju

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Internal displacement and the vulnerability of women are two critical aspects of forced migration that have dominated both global and local discourses. Statistics show that in November 2021, there were over 2.1 million internally displaced persons (IDPs) in Nigeria. Literature also states that displaced women and girls are more vulnerable than displaced men. They are susceptible to adversative experiences, including various forms of sexual violence and rape. As a result, the displaced women and girls are faced with psychological and physical traumas, including HIV/AIDS as well as unexpected or poorly spaced pregnancies. In addition, the poor condition of living of internally displaced women in IDP camps affects their reproductive health, pregnancy outcomes, and maternal mortality levels. Incontrovertibly, internally displaced women constitute an imperative contributor to the ills of Nigeria's maternal health status, which is the second worse globally and the worst in Africa. World Health Organisation statistics showed that approximately 536,000 girls and women die from pregnancy-related causes globally, and Nigeria accounts for 14% of the global maternal deaths. Undeniably, this supports the claims that maternal mortality remains a challenge in Nigeria and can be exacerbated by internal displacement crises. Therefore, maternal mortality remains a critical impediment to the actualisation of the 3.1 SDG target. Owing to this, concerns arise about the quality of the policy in Nigeria’s health sector. More specifically, this study is concerned with the maternal health care services displaced women receive in IDP camps in the three states affected by internal displacement in north-central Nigeria, an understudied area. The novelty of the study also lies in its comparative investigation of maternal healthcare service delivery in three different camp structures (faith-based, government, and informal IDP camps), a pattern that is absent in literature. Therefore, this study will investigate how the camp structures affect access to maternal health services in the study areas; analyse the successes and challenges in the delivery of maternal health care services to displaced women in the various camps; and recommendation and strategies for reducing maternal healthcare disparities/gaps across IDP camps in Nigeria (should they exist). It will adopt a mixed-method approach and multi-stage sampling technique. A total of 1,152 copies of the study questionnaire will be distributed to displaced pregnant and nursing mothers (PNM); nine focus group discussions will also be held with the displaced PNM; in-depth interviews will be conducted with humanitarian actors, policymakers, and health professionals. The quantitative and qualitative data will be analysed using Statistical Package for Social Science (SPSS) 21.0 and thematic analysis, respectively. The findings of the study will be used to develop a model of care that will address the fragmentations in Nigeria's healthcare system. The findings will also inform the development of best policies and practices in the maternal health of displaced women.

Keywords: forced displacement, internally displaced women, maternal healthcare, maternal mortality

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Authors: N. Pritchard

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Within architectural education, students arrive fore-armed with; their life-experience; knowledge gained from subject-based learning; their brains and more specifically their imaginations. The learning-by-doing that they embark on in studio-based/project-based learning calls for supervision that allows the student to proactively undertake research and experimentation with design solution possibilities. The degree to which this supervision includes direction is subject to debate and differing opinion. It can be argued that if the student is to learn-by-doing, then design decision making within the design process needs to be instigated and owned by the student so that they have the ability to personally reflect on and evaluate those decisions. Within this premise lies the problem that the student's endeavours can become unstructured and unfocused as they work their way into a new and complex activity. A resultant weakness can be that the design activity is compartmented and not holistic or comprehensive, and therefore, the student's reflections are consequently impoverished in terms of providing a positive, informative feedback loop. The construct proffered in this paper is that a supportive 'armature' or 'Heuristic-Framework' can be developed that facilitates a holistic approach and reflective learning. The normal explorations of architectural design comprise: Analysing the site and context, reviewing building precedents, assimilating the briefing information. However, the student can still be compromised by 'not knowing what they need to know'. The long-serving triad 'Firmness, Commodity and Delight' provides a broad-brush framework of considerations to explore and integrate into good design. If this were further atomised in subdivision formed from the disparate aspects of architectural design that need to be considered within the design process, then the student could sieve through the facts more methodically and reflectively in terms of considering their interrelationship conflict and alliances. The words facts and sieve hold the acronym of the aspects that form the Heuristic-Framework: Function, Aesthetics, Context, Tectonics, Spatial, Servicing, Infrastructure, Environmental, Value and Ecological issues. The Heuristic could be used as a Hermeneutic Model with each aspect of design being focused on and considered in abstraction and then considered in its relation to other aspect and the design proposal as a whole. Importantly, the heuristic could be used as a method for gathering information and enhancing the design brief. The more poetic, mysterious, intuitive, unconscious processes should still be able to occur for the student. The Heuristic-Framework should not be seen as comprehensive prescriptive formulaic or inhibiting to the wide exploration of possibilities and solutions within the architectural design process.

Keywords: atomistic, hermeneutic, holistic, approach architectural design studio education

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Authors: Vaibhav Dalmia, Manoj Phirke, Renith G

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With the wide adoption of UAVs (unmanned aerial vehicles) in various industries by the government as well as private corporations for solving computer vision tasks it’s necessary that their potential is analyzed completely. Recent advances in Deep Learning have also left us with a plethora of algorithms to solve different computer vision tasks. This study provides a comprehensive survey on solving the Visual Object Tracking problem and explains the tradeoffs involved in building a real-time yet reasonably accurate object tracking system for UAVs by looking at existing methods and evaluating them on the aerial datasets. Finally, the best trackers suitable for UAV-based applications are provided.

Keywords: deep learning, drones, single object tracking, visual object tracking, UAVs

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Authors: N. C. van der Merwe, J. Oosthuizen, M. F. Makhetha, J. Adams, B. K. Dajee, S-R. Schneider

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Women representing high-risk breast cancer families, who tested negative for pathogenic mutations in BRCA1 and BRCA2, are four times more likely to develop breast cancer compared to women in the general population. Sequencing of genes involved in genomic stability and DNA repair led to the identification of novel contributors to familial breast cancer risk. These include BLM and PALB2. Bloom's syndrome is a rare homozygous autosomal recessive chromosomal instability disorder with a high incidence of various types of neoplasia and is associated with breast cancer when in a heterozygous state. PALB2, on the other hand, binds to BRCA2 and together, they partake actively in DNA damage repair. Archived DNA samples of 66 BRCA1/2 negative high-risk breast cancer patients were retrospectively selected based on the presence of an extensive family history of the disease ( > 3 affecteds per family). All coding regions and splice-site boundaries of both genes were screened using High-Resolution Melting Analysis. Samples exhibiting variation were bi-directionally automated Sanger sequenced. The clinical significance of each variant was assessed using various in silico and splice site prediction algorithms. Comprehensive screening identified a total of 11 BLM and 26 PALB2 variants. The variants detected ranged from global to rare and included three novel mutations. Three BLM and two PALB2 likely pathogenic mutations were identified that could account for the disease in these extensive breast cancer families in the absence of BRCA mutations (BLM c.11T > A, p.V4D; BLM c.2603C > T, p.P868L; BLM c.3961G > A, p.V1321I; PALB2 c.421C > T, p.Gln141Ter; PALB2 c.508A > T, p.Arg170Ter). Conclusion: The study confirmed the contribution of pathogenic mutations in BLM and PALB2 to the familial breast cancer burden in South Africa. It explained the presence of the disease in 7.5% of the BRCA1/2 negative families with an extensive family history of breast cancer. Segregation analysis will be performed to confirm the clinical impact of these mutations for each of these families. These results justify the inclusion of both these genes in a comprehensive breast and ovarian next generation sequencing cancer panel and should be screened simultaneously with BRCA1 and BRCA2 as it might explain a significant percentage of familial breast and ovarian cancer in South Africa.

Keywords: Bloom Syndrome, familial breast cancer, PALB2, South Africa

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Authors: Gulfam Haider, sana danish

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Convolutional Neural Networks (CNNs) have emerged as powerful tools for image classification, and the choice of optimizers profoundly affects their performance. The study of optimizers and their adaptations remains a topic of significant importance in machine learning research. While numerous studies have explored and advocated for various optimizers, the efficacy of these optimization techniques is still subject to scrutiny. This work aims to address the challenges surrounding the effectiveness of optimizers by conducting a comprehensive analysis and evaluation. The primary focus of this investigation lies in examining the performance of different optimizers when employed in conjunction with the popular activation function, Rectified Linear Unit (ReLU). By incorporating ReLU, known for its favorable properties in prior research, the aim is to bolster the effectiveness of the optimizers under scrutiny. Specifically, we evaluate the adjustment of these optimizers with both the original Softmax activation function and the modified ReLU activation function, carefully assessing their impact on overall performance. To achieve this, a series of experiments are conducted using a well-established benchmark dataset for image classification tasks, namely the Canadian Institute for Advanced Research dataset (CIFAR-10). The selected optimizers for investigation encompass a range of prominent algorithms, including Adam, Root Mean Squared Propagation (RMSprop), Adaptive Learning Rate Method (Adadelta), Adaptive Gradient Algorithm (Adagrad), and Stochastic Gradient Descent (SGD). The performance analysis encompasses a comprehensive evaluation of the classification accuracy, convergence speed, and robustness of the CNN models trained with each optimizer. Through rigorous experimentation and meticulous assessment, we discern the strengths and weaknesses of the different optimization techniques, providing valuable insights into their suitability for image classification tasks. By conducting this in-depth study, we contribute to the existing body of knowledge surrounding optimizers in CNNs, shedding light on their performance characteristics for image classification. The findings gleaned from this research serve to guide researchers and practitioners in making informed decisions when selecting optimizers and activation functions, thus advancing the state-of-the-art in the field of image classification with convolutional neural networks.

Keywords: deep neural network, optimizers, RMsprop, ReLU, stochastic gradient descent

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Authors: Yi-Fan Lin, Peter P. Howley, Frank A. Tuyl

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Quality measurement and reporting systems are used in healthcare internationally. In Australia, the Australian Council on Healthcare Standards records and reports hundreds of clinical indicators (CIs) nationally across the healthcare system. These CIs are measures of performance in the clinical setting, and are used as a screening tool to help assess whether a standard of care is being met. Existing analysis and reporting of these CIs incorporate Bayesian methods to address sampling variation; however, such assessments are retrospective in nature, reporting upon the previous six or twelve months of data. The use of Bayesian methods within statistical process control for monitoring systems is an important pursuit to support more timely decision-making. Our research has developed and assessed a new graphical monitoring tool, similar to a control chart, based on the beta-binomial posterior predictive (BBPP) distribution to facilitate the real-time assessment of health care organizational performance via CIs. The BBPP charts have been compared with the traditional Bernoulli CUSUM (BC) chart by simulation. The more traditional “central” and “highest posterior density” (HPD) interval approaches were each considered to define the limits, and the multiple charts were compared via in-control and out-of-control average run lengths (ARLs), assuming that the parameter representing the underlying CI rate (proportion of cases with an event of interest) required estimation. Preliminary results have identified that the BBPP chart with HPD-based control limits provides better out-of-control run length performance than the central interval-based and BC charts. Further, the BC chart’s performance may be improved by using Bayesian parameter estimation of the underlying CI rate.

Keywords: average run length (ARL), bernoulli cusum (BC) chart, beta binomial posterior predictive (BBPP) distribution, clinical indicator (CI), healthcare organization (HCO), highest posterior density (HPD) interval

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Authors: Lukas Kober, Vladimir Littva, Vladimir Siska

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The pandemic has had a significant impact on our lives. One of the most affected professions is the nursing profession. Nurses are closest to the patient, spend the most time with him, support him, often replace the closest family members, and of course, are part of the whole treatment process. Current nurses have more competencies and roles than in the past. The healthcare system has reached a turning point, also in connection with the spreading Delta variant and the risk of the arrival of the third wave. The lack of nurses is a long-term problem, but it did not arise by itself. The reasons for the departure of nurses from the health care system are not only due to the increasing average age of nurses and midwives in Slovakia and their retirement. Thousands of nurses are leaving due to poor working conditions, low wages, and poor management of individual workplaces. We need to keep older nurses in the health care system, otherwise, we risk their early departure. The pandemic only exacerbates this situation, and the associated risks, such as occupational infections or enormous overload and exhaustion, only accelerate the exit from the profession. According to current data from the register of nurses and midwives, we canceled 772 registrations from January to September 2021, and 584 nurses requested the suspension of registration due to non-performance of the profession. During the same period, we registered only 240 new nurses graduate. We have had this significant disparity here for a long time. For the whole of 2020, we canceled 911 registrations and suspended 973 registrations. We registered a total of 389 graduates. Our system loses hundreds of graduates a year and loses experienced nurses with decades of experience who leave due to poor working conditions, wages and suffer from burnout. Such compensation should also be awarded to the families of health professionals who have lost their lives due to work and to COVID-19. These options can also be motivating for promising people interested in studying nursing, who can gradually replace the missing workforce. This purchase is supported by the KEGA project no. 015KU-4/2019.

Keywords: pandemic, COVID-19, nursing, nursing workforce, lack of nurses

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Authors: Lilian Nantume Wampande

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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.

Keywords: adolescent, HIV, support groups, Uganda

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Authors: Saba Ebrahimi, Hedieh Ashrafi

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Predicting the cover type of forests is a challenge for natural resource managers. In this project, we aim to perform a comprehensive comparative study of two well-known classification methods, support vector machine (SVM) and decision tree (DT). The comparison is first performed among different types of each classifier, and then the best of each classifier will be compared by considering different evaluation metrics. The effect of boosting and bagging for decision trees is also explored. Furthermore, the effect of principal component analysis (PCA) and feature selection is also investigated. During the project, the forest cover-type dataset from the remote sensing and GIS program is used in all computations.

Keywords: classification methods, support vector machine, decision tree, forest cover-type dataset

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Authors: Bo Wang

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This paper proposes a method that can estimate PM2.5 by the images of GF-1 Satellite that called WFOV images (Wide Field of View). AOD (Aerosol Optical Depth) over land surfaces was retrieved in Shanghai area based on DDV (Dark Dense Vegetation) method. PM2.5 information, gathered from ground monitoring stations hourly, was fitted with AOD using different polynomial coefficients, and then the correlation coefficient between them was calculated. The results showed that, the GF-1 WFOV images can meet the requirement of retrieving AOD, and the correlation coefficient between the retrieved AOD and PM2.5 was high. If more detailed and comprehensive data is provided, the accuracy could be improved and the parameters can be more precise in the future.

Keywords: remote sensing retrieve, PM 2.5, GF-1, aerosol optical depth

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Authors: Etienne K. Ngoy

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This analysis suggests that the comprehensive degradation caused by any environmental factor on fiber reinforced plastics under mechanical stress can be measured as a change in viscoelastic properties of the material. The change in viscoelastic characteristics is experimentally determined as a time-dependent function expressing the amplification of the stress relaxation. The variation of this experimental function provides a measure of the environmental degradation rate. Where real service environment conditions can be reliably simulated in the laboratory, it is possible to generate master curves that include environmental degradation effect and hence predict the durability of the fiber reinforced plastics under environmental degradation.

Keywords: environmental effects, fiber reinforced plastics durability, prediction, stress effect

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Authors: Khalifa Al Baloushi, Hongwei Zhang, Terrence Perera

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Over the last few decades, the government of the UAE has been taking actions to consolidate defense manufacturing entities with the view to build a coherent and modern defense manufacturing base. Whilst these actions have significantly improved the overall capabilities of defense manufacturing; further opportunities exist to radically transform the sector. A comprehensive literature review and data collected from a survey identified three potential areas of improvements, (a) integration of Industry 4.0 technologies and other smart technologies, (b) stronger engagement of small and Medium-sized defense manufacturing companies and (c) Enhancing the national defense policies by embedding best practices from other nations. This research paper presents the design and development of a conceptual framework for the UAE defense industrial ecosystem.

Keywords: industry 4.0, defense manufacturing, eco-systems, integration

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Authors: Subhash Nerella, Ziyuan Guan, Azra Bihorac, Parisa Rashidi

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Intensive care units (ICUs) provide care to critically ill patients in severe and life-threatening conditions. However, patient monitoring in the ICU is limited by the time and resource constraints imposed on healthcare providers. Many critical care indices such as mobility are still manually assessed, which can be subjective, prone to human errors, and lack granularity. Other important aspects, such as environmental factors, are not monitored at all. For example, critically ill patients often experience circadian disruptions due to the absence of effective environmental “timekeepers” such as the light/dark cycle and the systemic effect of acute illness on chronobiologic markers. Although the occurrence of delirium is associated with circadian disruption risk factors, these factors are not routinely monitored in the ICU. Hence, there is a critical unmet need to develop systems for precise and real-time assessment through novel enabling technologies. We have developed the mobility and circadian disruption quantification system (Mobi-DiQ) by augmenting biomarker and clinical data with pervasive sensing data to generate mobility and circadian cues related to mobility, nightly disruptions, and light and noise exposure. We hypothesize that Mobi-DiQ can provide accurate mobility and circadian cues that correlate with bedside clinical mobility assessments and circadian biomarkers, ultimately important for delirium risk assessment and prevention. The collected multimodal dataset consists of depth images, Electromyography (EMG) data, patient extremity movement captured by accelerometers, ambient light levels, Sound Pressure Level (SPL), and indoor air quality measured by volatile organic compounds, and the equivalent CO₂ concentration. For delirium risk assessment, the system recognizes mobility cues (axial body movement features and body key points) and circadian cues, including nightly disruptions, ambient SPL, and light intensity, as well as other environmental factors such as indoor air quality. The Mobi-DiQ system consists of three major components: the pervasive sensing system, a data storage and analysis server, and a data annotation system. For data collection, six local pervasive sensing systems were deployed, including a local computer and sensors. A video recording tool with graphical user interface (GUI) developed in python was used to capture depth image frames for analyzing patient mobility. All sensor data is encrypted, then automatically uploaded to the Mobi-DiQ server through a secured VPN connection. Several data pipelines are developed to automate the data transfer, curation, and data preparation for annotation and model training. The data curation and post-processing are performed on the server. A custom secure annotation tool with GUI was developed to annotate depth activity data. The annotation tool is linked to the MongoDB database to record the data annotation and to provide summarization. Docker containers are also utilized to manage services and pipelines running on the server in an isolated manner. The processed clinical data and annotations are used to train and develop real-time pervasive sensing systems to augment clinical decision-making and promote targeted interventions. In the future, we intend to evaluate our system as a clinical implementation trial, as well as to refine and validate it by using other data sources, including neurological data obtained through continuous electroencephalography (EEG).

Keywords: deep learning, delirium, healthcare, pervasive sensing

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Authors: Nsikan Affiah, Kayode Osungbade, Williams Uzoma

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Malaria remains one of the major killers of humans worldwide, threatening the lives of more than one-third of the world’s population. Some people refers it to; a disease of poverty because it contributes towards national poverty through its impact on foreign direct investment, tourism, labour productivity, and trade. At the micro level, it may cause poverty through spending on health care, income losses, and premature deaths. Unfortunately, malaria is a disease that affects both low-income household and its high-income counterpart, but low-income households are still at greater risk because significant part of the available monthly income is dedicated to various preventive and treatment measures. The objective of this study is to estimate direct and indirect cost of malaria treatment in households in a section of South-South Region (Akwa Ibom State) of Nigeria. A cross-sectional study of Six Hundred and Forty (640) heads of households or any adult representative of households in three local government areas of Akwa Ibom State, Nigeria from May 1-31, 2015 were ascertained through interviewer-administered questionnaire adapted from Nigerian Malaria Indicator Survey Report. The clustering technique was used to select 640 households with the help of Primary Health Care (PHC) house numbering system. Using exchange rate of 197 Naira/USD, result shows that direct cost of malaria treatment was 8,894.44 USD while the indirect cost of malaria treatment was 11,012.81 USD. Total cost of treatment made up of 44.7% direct cost and 55.3% indirect cost, with average direct cost of malaria treatment per household estimated at 20.6 USD and the average indirect cost of treatment per household estimated at 25.1 USD. Average total cost for each episode (888) of malaria was estimated at 22.4 USD. While at household level, the average total cost was estimated at 45.5 USD. From the average total cost, low-income households would spend 36% of monthly household income on treating malaria and the impact could be said to be catastrophic, compared to high-income households where only 1.2% of monthly household income is spent on malaria treatment. It could be concluded that the cost of malaria treatment is well beyond the means of households and given the reality of repeated bouts of malaria and its contribution to the impoverishment of households, there is a need for urgent action.

Keywords: direct cost, indirect cost, low income households, malaria

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Authors: Pawel Sowa, Joachim Bargiel

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This paper presents modern solutions of distributed generation in rural communities aiming at the improvement of energy and environmental security, as well as power supply reliability to important customers (e.g. health care, sensitive consumer required continuity). Distributed sources are mainly gas and biogas cogeneration units, as well as wind and photovoltaic sources. Some examples of their applications in a selected Silesian community are given.

Keywords: energy security, mini energy centres , power engineering, power supply reliability

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Authors: Yan Ding, Fei Yan, Ji Liang, Hong Jiang, Xiaoguang Yang, Xu Qian

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The health status of GonjiKolela District, Amhara Region, Ethiopia is below its national average, and a sub-project of China UK Global Health Support Programme (GHSP) is expected to increase the uptake of a suite of reproductive, maternal, newborn and child health (RMNCH) interventions there. To explore what is on the ground and what could be helpful for the uptake of RMNCH services in GonjiKolela, a qualitative study was performed as part of the baseline assessment before the implementation of the project. Nine key informants from GonjiKolela were interviewed with self-designed interview guides and they were from the district Health Office, health centers, health posts, women health development army (community volunteer groups), mothers of newborns, and also a gynecologist from the maternal and child health center which is the referral center for pregnant women for this project. The interview were transcribed into words and sorted with qualitative analysis software MAXqda. Content analysis was mainly used to analyze the data. The district health office, the health centers and the health posts all had focal persons taking care of the management and provision of RMNCH services, and RMNCH related indicators were recorded and reported at each level routinely. In addition, district government and administration at community/administrative village level kept a close eye on the reduction of maternal, neonatal and child mortality. Women Health Development Amy at household level supported health workers at community/administrative village level (called health extension workers) in tracing, recording and reporting pregnant women, newborn and under-five children,organizing events for health education, demonstrating and leading health promotion activities, and stimulating the utilization of RMNCH.

Keywords: Reproductive Maternal Newborn and Child Health, Health Care Utilization, Qualitative Study, Ethiopia

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Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

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In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Ahmed Belgasem, Walid Ben Hussin, Emad Krekshi, Jamal Hashad

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Waxy crude oil, characterized by its high paraffin wax content, poses significant challenges in the oil & gas industry due to its increased viscosity and semi-solid state at reduced temperatures. The wax formation process, which includes precipitation, crystallization, and deposition, becomes problematic when crude oil temperatures fall below the wax appearance temperature (WAT) or cloud point. Addressing these issues, this paper introduces a technical solution designed to mitigate the wax appearance and enhance the oil production process in Abu-Attifil Field via a 30-inch crude oil pipeline. A comprehensive flow assurance study validates the feasibility and performance of this solution across various production rates, temperatures, and operational scenarios. The study's findings indicate that maintaining the crude oil's temperature above a minimum threshold of 63°C is achievable through the strategic placement of two heating stations along the pipeline route. This approach effectively prevents wax deposition, gelling, and subsequent mobility complications, thereby bolstering the overall efficiency, reliability, safety, and economic viability of the production process. Moreover, this solution significantly curtails the environmental repercussions traditionally associated with wax deposition, which can accumulate up to 7,500kg. The research methodology involves a comprehensive flow assurance study to validate the feasibility and performance of the proposed solution. The study considers various production rates, temperatures, and operational scenarios. It includes crude oil analysis to determine the wax appearance temperature (WAT), as well as the evaluation and comparison of operating options for the heating stations. The study's findings indicate that the proposed solution effectively prevents wax deposition, gelling, and subsequent mobility complications. By maintaining the crude oil's temperature above the specified threshold, the solution improves the overall efficiency, reliability, safety, and economic viability of the oil production process. Additionally, the solution contributes to reducing environmental repercussions associated with wax deposition. The research conclusion presents a technical solution that optimizes oil production in the Abu-Attifil Field by addressing wax formation problems through the strategic placement of two heating stations. The solution effectively prevents wax deposition, improves overall operational efficiency, and contributes to environmental sustainability. Further research is suggested for field data validation and cost-benefit analysis exploration.

Keywords: oil production, wax depositions, solar cells, heating stations

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Authors: Alexandru Grigorescu, Alexandra Protesanu

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Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage. The aim is to provide evidence-based data for pain prevalence, diagnosis and treatment recommendations on an integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital. Patients and method: Consultation registers and electronic records of 166 Patients (Pts) were studied from April 2022 to March 2023. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain, investigations were carried out: bone scintigraphy, CT scan, and PET-CT. The analgesic treatments were represented by weak and strong morphine, radiotherapy, and bisphosphonates. Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, and kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, and post-surgical status. Drug treatment: Tramadol 47 Pts, of which 10 switched to a major opioid (Oxycodonum, Morphine sulfate), 20 Pts were treated with Oxycodonum as the first intention. In 5 patients ry to rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. All patients and their families were advised by a medical oncologist and psychologist for a lifestyle change. Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphine represented the main pain therapy. Palliative radiotherapy was the second most effective therapy. Treatment with bisphosphonates was useful. Surgical interventions were rarely indicated. Discussions with patients and their families regarding the lifestyle change were important.

Keywords: cancer pain, opioids, medical oncology, palliative care

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Authors: Abbas Ali Husseini, Ali Mohammad Yazdani, Fatemeh Ghadiri, Alper Şişman

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We developed a microchip device that uses surface acoustic waves for rapid lysis of low level of cell samples. The device incorporates sharp-edge glass microparticles for improved performance. We optimized the lysis conditions for high efficiency and evaluated the device's feasibility for point-of-care applications. The microchip contains a 13-finger pair interdigital transducer with a 30-degree focused angle. It generates high-intensity acoustic beams that converge 6 mm away. The microchip operates at a frequency of 16 MHz, exciting Rayleigh waves with a 250 µm wavelength on the LiNbO3 substrate. Cell lysis occurs when Candida albicans cells and glass particles are placed within the focal area. The high-intensity surface acoustic waves induce centrifugal forces on the cells and glass particles, resulting in cell lysis through lateral forces from the sharp-edge glass particles. We conducted 42 pilot cell lysis experiments to optimize the surface acoustic wave-induced streaming. We varied electrical power, droplet volume, glass particle size, concentration, and lysis time. A regression machine-learning model determined the impact of each parameter on lysis efficiency. Based on these findings, we predicted optimal conditions: electrical signal of 2.5 W, sample volume of 20 µl, glass particle size below 10 µm, concentration of 0.2 µg, and a 5-minute lysis period. Downstream analysis successfully amplified a DNA target fragment directly from the lysate. The study presents an efficient microchip-based cell lysis method employing acoustic streaming and microparticle collisions within microdroplets. Integration of a surface acoustic wave-based lysis chip with an isothermal amplification method enables swift point-of-care applications.

Keywords: cell lysis, surface acoustic wave, micro-glass particle, droplet

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Authors: Elizabeth Perry, Jylana Sheats

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Scholars posit that there is an overlap between the fields of Behavioral Economics (BE) and Behavior Science (BSci)—and that consideration of concepts from both may facilitate a greater understanding of health decision-making processes. For example, the ‘intention-action gap’ is one BE concept to explain sup-optimal decision-making. It is described as having knowledge that does not translate into behavior. Complementary best BSci practices may provide insights into behavioral determinants and relevant behavior change techniques (BCT). Within the context of BSci, this exploratory study aimed to apply a BE concept with demonstrated effectiveness in financial decision-making to a health behavior: influenza (flu) vaccine uptake. Adults aged >18 years were recruited on Amazon’s Mechanical Turk, a digital labor market where anonymous users perform simple tasks at low cost. Eligible participants were randomized into 2 groups, reviewed a scenario, and then completed a survey on the likelihood of receiving a flu shot. The ‘usual care’ group’s scenario included standard CDC guidance that supported the behavior. The ‘intervention’ group’s scenario included messaging about people who did not receive the flu shot. The framing was such that participants could learn from others’ (strangers) mistakes and the subsequent health consequences: ‘Last year, other people who didn’t get the vaccine were about twice as likely to get the flu, and a number of them were hospitalized or even died. Don’t risk it.’ Descriptive statistics and chi-square analyses were performed on the sample. There were 648 participants (usual care, n=326; int., n=322). Among racial/ethnic minorities (n=169; 57% aged < 40), the intervention group was 22% more likely to report that they were ‘extremely’ or ‘moderately’ likely to get the flu vaccine (p = 0.11). While not statistically significant, findings suggest that framing messages from the perspective of learning from the mistakes of unknown others coupled with the BCT ‘knowledge about the health consequences’ may help influence flu vaccine uptake among the study population. With the widely documented disparities in vaccine uptake, exploration of the complementary application of these concepts and strategies may be critical.

Keywords: public health, decision-making, vaccination, behavioral science

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Authors: Sijie Fu, Pascal-Henry Biwolé, Christian Mathis

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Among modern airflow measurement methods, Particle Image Velocimetry (PIV) and Particle Tracking Velocimetry (PTV), as visualized and non-instructive measurement techniques, are playing more important role. This paper conducts a comparative experimental study for airflow measurement employing both techniques with the same condition. Velocity vector fields, velocity contour fields, voticity profiles and turbulence profiles are selected as the comparison indexes. The results show that the performance of both PIV and PTV techniques for airflow measurement is satisfied, but some differences between the both techniques are existed, it suggests that selecting the measurement technique should be based on a comprehensive consideration.

Keywords: airflow measurement, comparison, PIV, PTV

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Authors: Hela Ghali, Oumayma Ben Amor, Salwa Khefacha, Mohamed Ben Rejeb, Sirine Frigui, Meriam Tourki Dhidah, Lamine Dhidah, Houyem Said Laatiri

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Background: Blood exposure accidents are the most common problem in hospitals that threaten healthcare professionals with a high risk of infectious complications which weighs heavily on health systems worldwide. Paramedics are the highest risk group due to the nature of their daily activities. We aimed to determine knowledge and attitudes about the management of blood-exposure accidents among nurses and technicians in two pediatric departments. Materials/Methods: This is a cross-sectional descriptive study conducted on March 2017, carried out with the care staff of the pediatric ward of the Farhat Hached Teaching Hospital of Sousse and pediatric surgery of the Fattouma Bourguiba University Hospital in Monastir, using a pre- tested and self-administered questionnaire. Data entry and analysis were performed using Excel software. Results: The response rate was 85.1%. A female predominance (82.5%) was reported among respondents with a sex ratio of 0.21. 80% of the participants were under 35 years old. Seniority of less than 10 years was found in 77.5% of respondents. Only 22.5% knew the definition of a blood- exposure accident. 100% and 95% of participants reported the relative risk, respectively, to hepatitis and AIDS viruses. However, only 15% recognized the severity factors of a blood-exposure accident. Hygiene compliance was the most important dimension for almost the entire population for the prevention. On the other hand, only 12.5% knew the meaning of 'standard precautions' and ¼ considered them necessary for at-risk patients only. 40% reported being exposed at least once, among them, 87.5% used betadine, and 77.5% said that anti-infectious chemoprophylaxis is necessary regardless of the patient's serological status. However, 52.5% did not know the official reporting circuit of management of blood-exposure accident in their institutions. Conclusion: For better management of risks in hospitals and an improvement of the safety of the care, a reinforcement of the sensibilization of the caregivers with regard to the risks of blood exposure accident is necessary, while developing their knowledge to act in security.

Keywords: attitudes, blood-exposure accident, knowledge, pediatric department

Procedia PDF Downloads 185

Authors: Kathryn Rooney, Kaitlyn Eddy, Evan Landers, Weihui Li

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The international mortality rate for neonates and infants has been declining at a disproportionally low rate when compared to the overall decline in child mortality in recent decades. A significant portion of infant deaths could be prevented with the implementation of low-cost and easy to use physiological monitoring devices, by enabling early identification of symptoms before they progress into life-threatening illnesses. The oral diagnostic device discussed in this paper serves to continuously monitor the key vital signs of body temperature, respiratory rate, heart rate, and oxygen saturation. The device mimics an infant pacifier, designed to be easily tolerated by infants as well as orthodontically inert. The fundamental measurements are gathered via thermistors and a pulse oximeter, each encapsulated in medical-grade silicone and wired internally to a microcontroller chip. The chip then translates the raw measurements into physiological values via an internal algorithm, before outputting the data to a liquid crystal display screen and an Android application. Additionally, a biological sample collection chamber is incorporated into the internal portion of the device. The movement within the oral chamber created by sucking on the pacifier-like device pushes saliva through a small check valve in the distal end, where it is accumulated and stored. The collection chamber can be easily removed, making the sample readily available to be tested for various diseases and analytes. With the vital sign monitoring and sample collection offered by this device, abnormal fluctuations in physiological parameters can be identified and appropriate medical care can be sought. This device enables preventative diagnosis for infants who may otherwise have gone undiagnosed, due to the inaccessibility of healthcare that plagues vast numbers of underprivileged populations.

Keywords: neonate mortality, infant mortality, low-cost diagnostics, vital signs, saliva testing, preventative care

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Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

Procedia PDF Downloads 128

Authors: Oktavian Prasetia Wardana, Martono Tri Utomo, Risa Etika, Kartika Darma Handayani, Dina Angelika, Wurry Ayuningtyas

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Background: Critically ill neonates are newborn babies with high-risk factors that potentially cause disability and/or death. Scoring systems for determining the severity of the disease have been widely developed as well as some designs for use in neonates. The SNAPPE-II method, which has been used as a mortality predictor scoring system in several referral centers, was found to be slow in assessing the outcome of critically ill neonates in the Neonatal Intensive Care Unit (NICU). Objective: To analyze the predictive value of MSNS on the outcome of critically ill neonates at the time of arrival up to 24 hours after being admitted to the NICU. Methods: A longitudinal observational analytic study based on medical record data was conducted from January to August 2022. Each sample was recorded from medical record data, including data on gestational age, mode of delivery, APGAR score at birth, resuscitation measures at birth, duration of resuscitation, post-resuscitation ventilation, physical examination at birth (including vital signs and any congenital abnormalities), the results of routine laboratory examinations, as well as the neonatal outcomes. Results: This study involved 105 critically ill neonates who were admitted to the NICU. The outcome of critically ill neonates was 50 (47.6%) neonates died, and 55 (52.4%) neonates lived. There were more males than females (61% vs. 39%). The mean gestational age of the subjects in this study was 33.8 ± 4.28 weeks, with the mean birth weight of the subjects being 1820.31 ± 33.18 g. The mean MSNS score of neonates with a deadly outcome was lower than that of the lived outcome. ROC curve with a cut point MSNS score <10.5 obtained an AUC of 93.5% (95% CI: 88.3-98.6) with a sensitivity value of 84% (95% CI: 80.5-94.9), specificity 80 % (CI 95%: 88.3-98.6), Positive Predictive Value (PPV) 79.2%, Negative Predictive Value (NPV) 84.6%, Risk Ratio (RR) 5.14 with Hosmer & Lemeshow test results p>0.05. Conclusion: The MSNS score has a good predictive value and good calibration of the outcomes of critically ill neonates admitted to the NICU.

Keywords: critically ill neonate, outcome, MSNS, NICU, predictive value

Procedia PDF Downloads 53

Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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