Background Sudan, a country once referred to as ‘a food basket', had an agricultural sector e... more Background Sudan, a country once referred to as ‘a food basket', had an agricultural sector employing 53% of the workforce (21.8% of the GDP) in 2019. However, intensive agricultural schemes and excessive use of pesticides have plagued this sector since colonial times, resulting in negative environmental health impacts. We analyzed relevant policies to identify deficiencies and improvement opportunities. Methods The National Pesticides and Pest Control Products Act (NPPCPA 1994), Environmental Health Act (EHA 2009), and the National Occupational Health Act (NOHA 1966) were analyzed. Results The laws governing pesticide handling and use are outdated. The NPPCPA (1994) does not capture recent regulations specified in international conventions. The EHA (2009) regulates the storage of vector-control pesticides, without referring to agricultural pesticides. NOHA was promulgated in 1966, yet the occupational health (OH) functions were formalized within the Federal Ministry of Health (...
Additional file 1. Overall outpatient visits and visits for common CLDs, URTI and presumed TB ove... more Additional file 1. Overall outpatient visits and visits for common CLDs, URTI and presumed TB over one-month by country and health facility.
SUMMARYBackgroundChronic respiratory diseases are considered a significant cause of morbidity and... more SUMMARYBackgroundChronic respiratory diseases are considered a significant cause of morbidity and mortality worldwide, although data from Africa are limited. This study aimed to determine the prevalence and determinants of chronic respiratory diseases in Khartoum, Sudan.MethodsData was collected from 516 participants, aged≥40, who had completed a questionnaire and undertook pre- and post-bronchodilator spirometry testing. Trained field workers conducted questionnaires and spirometry. Survey-weighted prevalence of respiratory symptoms and spirometric abnormalities were estimated. Regression analysis models were used to identify risk factors for chronic lung diseases.ResultsUsing the NHANESIII reference equations, the prevalence of Chronic Airflow Obstruction (CAO) was 10%. The main risk factor was older age 60-69 years (Odds ratio 3.16, 95% Confidence Interval 1.20 – 8.31). Lower education, high body mass index and a history of tuberculosis were also identified as significant risk fa...
Additional file 2. Availability of CLD guidelines, criteria for diagnosis and other guidelines by... more Additional file 2. Availability of CLD guidelines, criteria for diagnosis and other guidelines by health facility level in Tanzania and Sudan
Additional file 5. Arabic version of health care providers interview guides: This file captures t... more Additional file 5. Arabic version of health care providers interview guides: This file captures the multiple realities regarding the perception of health care providers about the change in working environment, quality of delivered services after the implementation of decentralization.
Additional file 6. English version of health care providers interview guides: This file captures ... more Additional file 6. English version of health care providers interview guides: This file captures the multiple realities regarding the perception of health care providers about the change in working environment, quality of delivered services after the implementation of decentralization.
This data set contains perceived effect of decentralization of health services on access to care ... more This data set contains perceived effect of decentralization of health services on access to care and quality of health services
BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are... more BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was sc...
Additional file 1. English version questionnaire:This file captures the perception of change amon... more Additional file 1. English version questionnaire:This file captures the perception of change among community members regarding the affordability, accessbility, availability and quality of healthcare services after decentralization implementation.
Additional file 4. Arabic version of interview guides for community members: This file captues th... more Additional file 4. Arabic version of interview guides for community members: This file captues the experienced change in the availability, affordability, accessbility and quality of health care services after implementation of decentralization as experienced by community members.
Additional file 3. English version interview guides for community members:This file captues the e... more Additional file 3. English version interview guides for community members:This file captues the experienced change in the availability, affordability, accessbility and quality of health care services after implementation of decentralization as experienced by community members.
Background Decentralization of healthcare services has been widely utilized, especially in develo... more Background Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial. Methods This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July–December 2015. Results Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported afforda...
Perceived consequences of healthcare service decentralization on access, affordability and quality of care in Khartoum locality, Sudan, 2021
Background: Decentralization of healthcare services has been widely utilized, especially in devel... more Background: Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial. Methods: This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July-December 2015. Results: Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53 and 55% before decentralization compared to 24 to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p = 0.01). The quality of healthcare services was reported to have declined from 47 and 38% before decentralization to 38 and 28% after, in KTH and IBMH respectively (p = 0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59 and 52% of the time, compared to 41 and 30% after, in KTH and IBMH catchment areas respectively, (p = 0.01). Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare.
Background Sudan, a country once referred to as ‘a food basket', had an agricultural sector e... more Background Sudan, a country once referred to as ‘a food basket', had an agricultural sector employing 53% of the workforce (21.8% of the GDP) in 2019. However, intensive agricultural schemes and excessive use of pesticides have plagued this sector since colonial times, resulting in negative environmental health impacts. We analyzed relevant policies to identify deficiencies and improvement opportunities. Methods The National Pesticides and Pest Control Products Act (NPPCPA 1994), Environmental Health Act (EHA 2009), and the National Occupational Health Act (NOHA 1966) were analyzed. Results The laws governing pesticide handling and use are outdated. The NPPCPA (1994) does not capture recent regulations specified in international conventions. The EHA (2009) regulates the storage of vector-control pesticides, without referring to agricultural pesticides. NOHA was promulgated in 1966, yet the occupational health (OH) functions were formalized within the Federal Ministry of Health (...
Additional file 1. Overall outpatient visits and visits for common CLDs, URTI and presumed TB ove... more Additional file 1. Overall outpatient visits and visits for common CLDs, URTI and presumed TB over one-month by country and health facility.
SUMMARYBackgroundChronic respiratory diseases are considered a significant cause of morbidity and... more SUMMARYBackgroundChronic respiratory diseases are considered a significant cause of morbidity and mortality worldwide, although data from Africa are limited. This study aimed to determine the prevalence and determinants of chronic respiratory diseases in Khartoum, Sudan.MethodsData was collected from 516 participants, aged≥40, who had completed a questionnaire and undertook pre- and post-bronchodilator spirometry testing. Trained field workers conducted questionnaires and spirometry. Survey-weighted prevalence of respiratory symptoms and spirometric abnormalities were estimated. Regression analysis models were used to identify risk factors for chronic lung diseases.ResultsUsing the NHANESIII reference equations, the prevalence of Chronic Airflow Obstruction (CAO) was 10%. The main risk factor was older age 60-69 years (Odds ratio 3.16, 95% Confidence Interval 1.20 – 8.31). Lower education, high body mass index and a history of tuberculosis were also identified as significant risk fa...
Additional file 2. Availability of CLD guidelines, criteria for diagnosis and other guidelines by... more Additional file 2. Availability of CLD guidelines, criteria for diagnosis and other guidelines by health facility level in Tanzania and Sudan
Additional file 5. Arabic version of health care providers interview guides: This file captures t... more Additional file 5. Arabic version of health care providers interview guides: This file captures the multiple realities regarding the perception of health care providers about the change in working environment, quality of delivered services after the implementation of decentralization.
Additional file 6. English version of health care providers interview guides: This file captures ... more Additional file 6. English version of health care providers interview guides: This file captures the multiple realities regarding the perception of health care providers about the change in working environment, quality of delivered services after the implementation of decentralization.
This data set contains perceived effect of decentralization of health services on access to care ... more This data set contains perceived effect of decentralization of health services on access to care and quality of health services
BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are... more BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was sc...
Additional file 1. English version questionnaire:This file captures the perception of change amon... more Additional file 1. English version questionnaire:This file captures the perception of change among community members regarding the affordability, accessbility, availability and quality of healthcare services after decentralization implementation.
Additional file 4. Arabic version of interview guides for community members: This file captues th... more Additional file 4. Arabic version of interview guides for community members: This file captues the experienced change in the availability, affordability, accessbility and quality of health care services after implementation of decentralization as experienced by community members.
Additional file 3. English version interview guides for community members:This file captues the e... more Additional file 3. English version interview guides for community members:This file captues the experienced change in the availability, affordability, accessbility and quality of health care services after implementation of decentralization as experienced by community members.
Background Decentralization of healthcare services has been widely utilized, especially in develo... more Background Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial. Methods This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July–December 2015. Results Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported afforda...
Perceived consequences of healthcare service decentralization on access, affordability and quality of care in Khartoum locality, Sudan, 2021
Background: Decentralization of healthcare services has been widely utilized, especially in devel... more Background: Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial. Methods: This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July-December 2015. Results: Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53 and 55% before decentralization compared to 24 to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p = 0.01). The quality of healthcare services was reported to have declined from 47 and 38% before decentralization to 38 and 28% after, in KTH and IBMH respectively (p = 0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59 and 52% of the time, compared to 41 and 30% after, in KTH and IBMH catchment areas respectively, (p = 0.01). Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare.
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