Conectar
by Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni
BackgroundCapacity for elective general surgical care is an important reflection of a health system’s ability to meet a population’s surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system.
MethodsWe conducted a qualitative study of 38 convenience-sampled patients diagnosed with an elective hernia condition at a tertiary referral hospital in Kenya between November 2023 and March 2024. We utilized Braun and Clarke’s six-step model of thematic analysis to generate key themes across the phases of care seeking, reaching and receiving as modeled in the Three Delays Framework.
ResultsWe identified three main cross-cutting themes including (1) the flow of power from patients to providers, and vice versa, take the form of consent or knowledge, respectively; (2) trust is a limited currency required for patients to engage with formal care; and (3) internal and external contextual factors remain the foundation for patient-provider care activities. We incorporated these themes together in a framework which illustrates the cyclical nature by which each factor feeds back on the others, ultimately affecting patient care.
ConclusionsFluctuating flows of patient power and trust interacts with existing infrastructural context to influence the ability of a health system to generate care. Recognizing the interaction of these key factors may have important bearing on the successful implementation of any larger systemic efforts or policies to improve access to elective surgical care.
The highest childhood mortality rates are observed from external causes of death. Our study aims to investigate the trends in deaths from external causes among children aged 0–14 years between 2000 and 2022, comparing the pre-pandemic (2000–2019) and the COVID-19 pandemic (2020–2022) periods.
This is a population-based retrospective cohort study.
From the ‘Dissemination Database’ of the Hungarian Central Statistical Office, we collected the monthly and annual mortality of all external causes (International Classification of Diseases, 10th Revision: V01–Y89) and the two most common external causes (traffic accidents and drownings) for the period 2000–2022.
Children aged under 15 years, and the relevant population, were available from this database by gender, 5-year age group and region.
The trends were characterised by the incidence rate ratio (IRR) and its 95% CI.
During the study period, 1813 deaths (1142 boys and 671 girls) occurred. There was a significant decreasing trend in all external-cause mortality (IRR=0.94; 95% CI 0.93 to 0.95; p
There is a significant decreasing annual trend in childhood external-cause mortality in Hungary. Mortality from drowning was significantly higher around our larger natural water bodies in the summer months, while mortality from traffic accidents was the highest in the HU33.
FreshRSS 