Telemedicine in Island Territories

Pregnancy may cause problems or become a complication at any time. However, complications of pregnancy and childbirth can be prevented by regular antenatal care (ANC) visits. Four ANC visits (K4) are indicators used to assess the quality of health services for pregnant women. Four ANC visits (K4) are also the indicators to see the frequency that refers to the trimester period when conducting a pregnancy check. Nationally, performance indicators for the coverage of four ANC visits (K4) on pregnant women in 2014 did not reach the target. There are various factors that may contribute to an unsuccessful four ANC visit (K4) of pregnant women that come from predisposing, enabling and reinforcing factors. The objective of the study is to investigate the correlation between maternal age and four ANC visits (K4) on TM III (trimester III) pregnant women at Danurejan I Primary Health Center of Yogyakarta. It is an analytic observational study design with cross-sectional approach. The sample was taken by accidental sampling technique with the inclusion and exclusion criteria as many as 30 TM III pregnant women. The result of this study shows that from four factors that analyzed, only two factors have a significant relationship with four ANC Visits (K4), which are maternal age (pv=0.000) and parity (pv=0.000). Meanwhile, education level (pv=0.155) and occupation (pv=0.210) have no correlation with four ANC Visits K4). Therefore, it can be concluded from this study that the maternal age and parity are the predisposing factors related to the four ANC Visits (K4). As a result, it is clear that promotion and prevention efforts such as health education about mature age at marriage and improving family planning programs are essential to increase four ANC Visits (K4). Future studies are expected to be conducted on larger sample sizes and different epidemiological approaches. Keywords: Pregnancy; Predisposing; Four ANC Visits Received: 5 June 2020 Reviewed: 18 July 2020 Revised: 24 July 2020 Accepted: 28 August 2020DOI: 10.35898/ghmj-41538

Maternal Mortality Rate (MMR) in 2012 was 359 per 100,000 live births. In 2015, based on 2015 SUPAS data, both MMR and IMR showed a decrease (MMR 305 / 100,000 KH; IMR 22.23 / 1000 KH). The purpose of this study was to determine the effect of the implementation of cadre assistance on antenatal care (ANC) visits of high-risk pregnant women in Jelakombo Jombang.This type of research is correlational with the Cross Sectional approach. Population 63 high risk pregnant women, sample 54 high risk pregnant women. The study was conducted from 03 to 17 July 2019. The independent variable was the implementation of cadre mentoring and the dependent variable was the ANC visit. The side technique used is simple random sampling. Data obtained from ANC questionnaire and MCH Book Checklist. Data analysis using the Mann Whitney test.The results of the implementation of cadre mentoring were quite good as many as 32 respondents (59.3%). ANC visits were mostly active in visiting ANC, namely 40 respondents (74.1%). Implementation of pregnant women by good cadres 32 respondents, most respondents 32 high risk mothers (93.8%) actively visited ANC. Statistical test results using the Mann-Whitney U test obtained r = 0,000 (r<0.05) so that Ho was rejected means that it was concluded there was a correlation between the Implementation of Cadre Assistance with ANC Visit of Risti Pregnant Women at Jelakombo Health Center in Jombang Regency.

Pregnancy is the result of the “dating” of sperm and egg. In the process, the sperm's journey to meet the egg (ovum) is really full of struggle. Of the approximately 20-40 million sperm released, only a few succeed in reaching the egg. Pregnancy care is important to ensure that the natural process of pregnancy runs normally and remains so at every antenatal visit after the first antenatal visit until delivery. Pregnancy visits were carried out as many as 6 KN. The aim was to examine the factors that influence the incompleteness of antenatal care visits at the Beutong Community Health Center, Beutong District, Nagan Raya Regency, Aceh Province in 2022. This research uses analytical observational research methods with the research design used by Cross Sectional. The sample in the research was 38 people using accidental sampling. The data collected in the research is primary data, namely data obtained directly from respondents. The data analysis used is chi square Tabulation research results There is a relationship between knowledge and incomplete antenatal care visits at the Beutong Health Center, Beutong District, Nagan Raya Regency, Aceh Province in 2022. This can be seen from the p value = 0.034 > 0.05 with a prevalence ratio of 0.143 (95% CI = 0.058 – 0.354). There is a relationship between family income and antenatal care visits, this can be seen from the p value = 0.049 < 0.05 with a prevalence ratio of 0.214 (95% CI = 0.471 – 0.967). There is no relationship between parity and maternal knowledge about antenatal visits. This can be seen from the p value = 0.094> 0.05 with a prevalence ratio of 1.222 (95% CI = 0.066 – 0.743). There is a relationship between work and incomplete antenatal care visits. This can be seen from the p value = 0.001 < 0.05 with a prevalence ratio 0.77 (95% CI = 0.20 – 0.291). There is a relationship between education and incomplete antenatal visits, this can be seen from the p value = 0.049 < 0.05 with a prevalence ratio of 0.214 (95% CI = 0.471 – 0.967) Conclusion: There is a significant relationship between knowledge and income, employment and education and the incompleteness of antenatal care visits at Beutong Community Health Center, Beutong District, Nagan Raya Regency, Aceh Province in 2022. And there is no relationship between parity and mother's knowledge about antenatal care visits at Beutong Community Health Center, Beutong District, Nagan Regency. Raya Aceh Province in 2022.

BackgroundInadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers’ ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments.MethodsCompleteness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12–15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level.ResultsComplete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p < 0.001). Similar improvements were found for 20 of 23 other essential ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits.ConclusionAssessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees’ education level and previous training in focused ANC. MESH-QI offers an approach to enhance quality of care after traditional training and may be an approach to support newer providers who have not yet attended content-focused courses.

BackgroundPrepaid contributory systems are increasingly being recognized as key mechanisms in achieving universal health coverage in low and middle-income countries. Peru created the Seguro Integral de Salud (SIS) to increase health service use amongst the poor by removing financial barriers. The SIS transfers funds on a fee-for-service basis to the regional health offices to cover recurrent cost (excluding salaries) of pre-specified packages of interventions. We aim to estimate the full cost of antenatal care (ANC) provision in the Ventanilla District (Callao-Peru) and to compare the actual cost to the reimbursement rates provided by SIS.MethodsThe economic costs of ANC provision in 2011 in 8 of the 15 health centres in Ventanilla District were estimated from a provider perspective and the actual costs of those services covered by the SIS fee of $3.8 for each ANC visit were calculated. A combination of step-down and bottom-up costing methodologies was used. Sensitivity analysis was conducted to test the uncertainty around estimated parameters and model assumptions. Results are reported in 2011 US$,ResultsThe total economic cost of ANC provision in all 8 health centres was $569,933 with an average cost per ANC visit of $31.3 (95 % CI $29.7–$33.5). Salaries comprised 74.4 % of the total cost. The average cost of the services covered by the SIS fee was $3.4 (95 % CI $3.0–$3.8) per ANC visit. Sensitivity analysis showed that the probability of the cost of an ANC visit being above the SIS reimbursed fee is 1.4 %.ConclusionOur analysis suggests that the fee reimbursed by the SIS will cover the cost that it supposed to cover. However, there are significant threats to medium and longer term sustainability of this system as fee transfers represent a small fraction of the total cost of providing ANC. Increasing ANC coverage requires the other funding sources of the Regional Health Office (DIRESA) to adapt to increasing demand.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-015-0042-z) contains supplementary material, which is available to authorized users.

Quality laboratory services are a requisite to guide rational case management of malaria. Using a pre-tested, standardized assessment tool, we assessed laboratory diagnostic capacity in 69 primary, secondary and tertiary health facilities as well as specialized laboratories in five administrative zones in Oromia Regional State, Ethiopia, during February and March 2009. There was marked variability in laboratory diagnostic capacity among the facilities assessed. Of 69 facilities surveyed, 53 provided both comprehensive malaria laboratory diagnosis and outpatient treatment services, five provided malaria microscopy services (referring elsewhere for treatment), and 11 primary care health posts provided rapid diagnostic testing and outpatient malaria treatment. The facilities' median catchment population was 39, 562 and 3581 people for secondary/tertiary and primary health facilities, respectively. Depending on facility type, facilities provided services 24 hrs a day, had inpatient capacity, and access to water and electricity. Facilities were staffed by general practitioners, health officers, nurses or health extension workers. Of the 58 facilities providing laboratory services, 24% of the 159 laboratory staff had received malaria microscopy training in the year prior to this survey, and 72% of the facilities had at least one functional electric binocular microscope. Facilities had variable levels of equipment, materials and biosafety procedures necessary for laboratory diagnosis of malaria. The mean monthly number of malaria blood films processed at secondary/tertiary facilities was 225, with a mean monthly 56 confirmed parasitologically. In primary facilities, the mean monthly number of clinical malaria cases seen was 75, of which 57 were tested by rapid diagnostic test (RDTs). None of the surveyed laboratory facilities had formal quality assurance/quality control protocols for either microscopy or RDTs. This is the first published report on malaria diagnostic capacity in Ethiopia. While our assessment indicated that malaria laboratory diagnosis was available in most facilities surveyed, we observed significant gaps in laboratory services which could significantly impact quality and accessibility of malaria diagnosis, including laboratory infrastructure, equipment, laboratory supplies and human resources.

Background: Maternal Mortality Rate (MMR) is one indicator that can describe the welfare of society in a country. According to data from the World Health Organization (WHO), maternal mortality in Indonesia in 2013 was still dominated by three main causes of death, namely bleeding by 30.13%, hypertension in pregnancy by 27.1%, and infection by 7.3%. one of the causes of maternal mortality in Indonesia whose incidence continues to increase, namely 1% in 2010 1.1% in 2011 and 1.8% in 2012. In monitoring the health service program for pregnant women, it can be assessed using the coverage indicators K1 and K4.Objective: The purpose of this study was to determine the knowledge relation of Pregnant Women about the danger signs of pregnancy with Antenatal Care (ANC) visits.Method: This research is an analytic study with a cross-sectional approach using primary and secondary data, primary data using a questionnaire with 20 questions. The sample used is 65 people, the sampling method is by accidental sampling techniqueResult: There is a relationship between knowledge of pregnant women about danger signs of pregnancy with antenatal care (ANC) visits where (X² count = 64.75) &gt; X² table (3.481) at Hamparan-Perak’s public Health Center in 2021Conclusion: There is a relationship between knowledge of pregnant women about danger signs of pregnancy with ANC visits at Hamparan-Perak’s public Health Center in 2021 Keywords: Knowledge; Pregnant Women; Danger Signs of Pregnancy; ANC Visits

Strengthening primary health care services is essential to improve the achievement of minimum health service standards. Primary Care Integration aims to reorganize existing primary health care services, enabling them to serve the entire Indonesian population with comprehensive and quality services by coordinating primary health care services based on the life cycle and no longer on programs. This study aims to explore the readiness of human resources, organization and governance, and technology in health centers to implement PCI. This descriptive study was conducted using a qualitative approach with 15 respondents from various job backgrounds. The research was conducted at Ipuh Bangun Jaya Health Center from August to October 2024. In-depth interview results were processed and validated through field observations, resulting in 18 sub-themes. Sub-themes 1-3 are about understanding PCI; sub-themes 4-8 are about human resource readiness; sub-themes 9-14 are about organizational and governance readiness; and sub-themes 15-18 are about technology readiness. Data analysis involved data reduction, data presentation, and conclusion and verification. The research findings show that Human Resources at Ipuh Bangun Jaya Health Center have good efficacy and individual attributes to support the implementation of primary care integration at the Health Center. The organization and governance of Ipuh Bangun Jaya Health Center show the existence of management support as one form of good principal support to move towards the implementation of primary care integration at the Health Center. The information technology available at Ipuh Bangun Jaya Health Center is adequate for the implementation of primary care integration at the Health Center as one of the available principal supports. Although the valence of change is not yet very strong, the efficacy of change and the situation of change have been felt and expressed by employees in their daily activities. Things that need to be improved to encourage change include: widespread socialization to all employees according to clusters, structured socialization of policy products, and adequate internet access. The study concludes that Ipuh Bangun Jaya Health Center has strong human resources, governance, and IT support for primary care integration. However, improvements in socialization and internet access are needed for successful implementation.

An Update on the South Carolina Trauma Initiative

Background: Complications during pregnancy is one of the variables increasing the maternal death rate. To reduce or prevent maternal and perinatal morbidity and mortality, antenatal care (ANC) visits were implemented. An antenatal care visit is pregnancy monitoring which is intended to inspect the health of the mother in general, including complications of pregnancy. It also aims to prepare a well-born neonate and a healthy mother; therefore, adherence to ANC is important. This study was conducted to determine the maternal determinant variables related to adherence to ANC. Methods: This cross-sectional study was carried out with an analytical approach. The statistical population of the research consisted of 30 pregnant women who were in the third trimester. The research design indicated the correlation between variables. A univariate data was used for the analysis of variables, namely maternal age, parity, and pregnancy diagnosis. While the bivariate analysis was performed using Fisher’s exact test. The study was conducted in Slawi Primary Health Centre, Indonesia. Results: The results showed that 86.67% of pregnant women conducted ANC visits regularly. According to maternal determinants, it was revealed that ANC had a correlation with age and parity (P=0.02 and P=0.04, respectively). However, there was no correlation between pregnancy diagnoses and ANC (P=0.08). Conclusion: There were correlations of age and parity with ANC; nevertheless, no correlation was found between pregnancy diagnosis and ANC.

Background: One of the key components of national rural health mission was to create a band of female health volunteers, appropriately named “accredited social health activist” (ASHA) in each village within the identified States to act as a bridge between the rural people and health services outlets. They act as health activists in community who will create awareness on health and its determinants, counsel mothers on key healthy behaviors and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. Objectives of the study was to describe the socio-demographic profile of ASHAs working in Vijayapur district and to evaluate the knowledge, attitude, practice of ASHAs towards the maternal care.Methods: A cross-sectional study on 617 ASHAs of Vijayapur district. A pre-designed, semi- structured questionnaire was prepared in English and the interview was conducted in Kannada by explaining them questions one by one.Results: Out of 617 ASHAs interviewed, 427 (69.2%) of them told a pregnant woman should have antenatal care (ANC) visits and 413 (65.3%) ASHAs opined that a minimum of four ANC visits are required. While 542 (87.2%) ASHAs told that they should accompany pregnant woman transport to health centre during labour pains and 570 (92.8%) told that they should stay with the pregnant lady until her delivery is over. Also, it was found that knowledge of ASHAs regarding maternal care was significantly associated with age and duration of service of ASHAs.Conclusions: On the whole, knowledge of ASHAs about care during pregnancy and care of new-born was considerably good.

Research ObjectiveLittle is known about the effectiveness of telemedicine for patients with serious mental illness (SMI). We sought to identify and describe characteristics of community mental health center (CMHC) SMI patients associated with treatment retention and use of telemedicine during this time.Study DesignThis research is an observational study of retention in services and use of telemedicine during 12/2019–6/2020 (compared to 12/2018–6/2019) in New Hampshire (NH) CMHC patients. Starting in 3/2020, patients were offered in person and/or telemedicine services based on clinical recommendation and personal choice. NH Medicaid claims provided CMHC service, diagnoses, and demographics. Quarterly use of telemedicine was categorized into <25%, 25–75%, or > 75% of total services. Associations between retention and demographic variables were explored using chi‐square test of independence, logistical regression and correspondence multivariate analysis.Population StudiedAll 16,030 NH Medicaid beneficiaries with SMI, including debilitating schizophrenia, bipolar disorder, major depression, PTSD, and anxiety/other diagnoses, who were engaged in CMHC treatment during the three months prior to the COVID‐19 State of Emergency (SOE) was declared in NH.Principal Findings81.7% of patients were retained in treatment in the quarter following the SOE declaration compared to 86.6% of patients in the 2018–2019 period. Comparing 2020 to 2019, youth demonstrated low retention rates (77% compared to 84%, respectively). In 2020, retention among patients with rural zip codes was lower than among those with urban zip codes (78.8% vs 81.2%), and among patients with PTSD (78.1%) and anxiety/ other diagnoses (76.5%) compared to schizophrenia (93.2%) and bipolar disorder (89%).All three multivariate analyses indicate that age, gender, and condition significantly predicted retention. In adjusted models, male gender, age group 18–34, and PTSD diagnosis predicted low retention. In contrast, female gender, age groups 35–54 and 55+, and schizophrenia and bipolar diagnoses predicted high retention.Similar analyses predicting level of telehealth services utilization showed: patients with <25% telehealth services were more likely in the 55+ year age group and schizophrenia diagnosis group; patients with 25% to 75% telehealth services were more likely to be youth and to have PTSD; those with 75% telehealth services were more likely to be in the 18–55 age group, and to have bipolar disorder or major depression.ConclusionsTelemedicine was utilized by the majority of CMHC patients in the months following the pandemic, likely supporting continuity of CMHC care for vulnerable patients with SMI. Yet, even with this substantial rollout of telemedicine, retention in treatment was less than retention in the prior year, and some sub‐populations were more at risk for treatment interruptions than others.Implications for Policy or PracticeTelemedicine promoted continuity of care during the pandemic but it is not clear how much telemedicine should continue after the pandemic, and for which subpopulations of people with SMI. Further research on the effectiveness and limitations of telemedicine in patients with SMI is needed to inform future policies and clinical practice.

Background: Based on WHO data (2020), Indonesia's Antenatal Care (ANC) coverage percentage (82%) is still far from the standards set compared to other countries, where pregnancy checks for ANC (K1) coverage are 96.1%, and ANC (K4) coverage is 96.1%. amounting to 74.1%. The target of the strategic plan (Renstra) related to K1 is 100&amp; and K6 coverage of pregnant women is 78%, in general it has not reached the target. The aim: of the research is to determine the analysis of factors influencing Antenatal Care (ANC) visits in the Sambas Port Health Center Working Area, Sibolga City in 2022 Metodh: The design of this research is analytical research using retrospective. The population in the study was all postpartum mothers ≤2 months, namely 216 people in October 2023. The sample used the Slovin formula, namely 68 respondents. The data used uses primary and secondary data. Data analysis using univariate, bivariate and multivariate using binary regression tests. Resulth: The research results were obtained using the chi square test, there was an influence of knowledge with Antenatal Care (ANC) visits (p= 0.017), there was no influence of employment with Antenatal Care (ANC) visits (p= 0.514), there was an influence of the role of health workers with Antenatal visits Care (ANC) (p= 0.001), there is an influence of husband's support with Antenatal Care (ANC) visits (p= 0.004), There is an influence of the attitude of health workers with Antenatal Care (ANC) visits (p= 0.027) and there is no influence of health facilities with Antenatal Care (ANC) visits (p= 0.017). The most dominant factor is the role of health workers with Antenatal Care (ANC) visits (p= 0.002) with an OR value of 6.160 (2.018-18.807). Conclusion: the is that there is an influence of knowledge, attitude, role of health workers, husband's support, attitude of health workers with Antenatal visits in the Sambas Port Health Center Working Area. It is hoped that health workers at the Sambas Harbor Health Center will improve the quality of KIA services so that they can increase KIA patient satisfaction.

During the Covid-19 pandemic, there were many changes, especially in health services due to efforts to prevent transmission of Covid-19 so that pregnant women experienced anxiety about visiting health facilities for fear of contracting Covid-19 and in health facilities service restrictions were also carried out from the previous schedule. This study aims to analyze the relationship between the anxiety of pregnant women during a pandemic and antenatal care visits in the UPTD area of ​​the Gunungsitoli District Health Center. This research uses quantitative methods and is a type of non-experimental research, with a cross-sectional design. This research was conducted in the working area of ​​the Gunung Sitoli City Health Center, Nias, North Sumatra in December 2022. The subjects of this study were pregnant women. The sampling technique in this study used simple random sampling with a total of 232 pregnant women. The instrument used is a questionnaire. From the results of bivariable analysis using the Chi-square test the relationship between anxiety and the accuracy of ANC visits was obtained p = 0.015 (p &lt;0.05). In conclusion, there is a significant relationship between anxiety and the accuracy of ANC visits.

To demonstrate the feasibility, from the public health standpoint, of preventing mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) in Africa. Voluntary counselling and HIV serotesting were routinely provided in four health centres in Abidjan, Côte d'Ivoire, for six months in 1998-99. Peripartum treatment with zidovudine and alternatives to breastfeeding were provided free to HIV-infected women. Of the 4309 pregnant women in the study who attended their first antenatal care visit, 3756 benefited from individual counselling and pretesting (87.2%), and 3452 (80.1%) agreed to undergo HIV serotesting. Overall HIV prevalence was (12.89%) and 5% for women aged under 18 years. Among the 2998 HIV-negative women, 71% returned for their test result, whereas only 60% of the 445 HIV-positive women did so. A total of 124 HIV-positive women were informed of their serostatus and the possibility of preventing mother-to-child transmission of HIV; 100 started treatment and 80 completed zidovudine prophylaxis. At 6 weeks of age, 36 of the 78 liveborn children were being breastfed (46%), two were being mixed-fed and 41 (52%) were being artificially fed. In Abidjan, voluntary counselling and HIV testing with a view to preventing mother-to-child transmission was feasible in antenatal care units and was well accepted by pregnant women. An insufficient proportion of women returned to obtain their test results. This was especially so among HIV-positive women, the target group for preventing mother-to-child transmission of HIV. Additional staff were required in order to offer voluntary counselling and HIV testing to the study women. Close supervision and strong commitment of health workers were essential. Alternatives to breastfeeding were effectively proposed to HIV-positive women, with active follow-up of children and clinical, nutritional and social support.