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Data quality was assured using several methods: Health-care facilities The observational tool was piloted in patients at 23 health-care facilities in Nairobi, which were selected to represent the wide range of facilities that provide primary health care in Kenya.
They included public, private not-for-profit and private commercial facilities of differing levels of complexity: The main study took place in Kakamega, Meru and Kilifi counties in different regions of Kenya.
Although the distribution of facilities by level of complexity was similar to that at the national and county level, the proportion of private facilities was higher, possibly because these facilities were under-represented in administrative data.
In higher-level facilities i. The mean age of the health-care workers was Statistical analysis We calculated the compliance by dividing the number of correct actions performed by the total number of indications and report the observed compliance with infection prevention and control practices for each domain i.
This implies that the implicit weight given to each individual action is the frequency with which it was observed.
We adopted this approach because the relative risk associated with different infection prevention and control practices in primary health care has not been established.
To assess whether compliance was associated with the individual characteristics of the health-care worker or facility, we proceeded in a stepwise fashion.
First, we used multiple linear regression to assess the association between the availability of supplies and compliance. Then, we used a similar analysis to assess the association between other characteristics and compliance in the subset of observations for which supplies were available since the compliance would necessarily be zero if essential supplies were unavailable.
In particular, it can be shown that, when supplies are necessary but not sufficient for compliance, the lower bound for the association between the availability of supplies and compliance is the mean compliance in the sample.
Consequently, the regression coefficient for the association between the availability of supplies and compliance will lie between the mean compliance in the sample and 1. In deriving standard errors, we adjusted for the effect of clustering at the level of the facility and of the health-care worker.
Data were analysed using Stata version Further details of the statistical methods are available from the corresponding author. Results In the pilot study, we found that: The mean overall compliance across the five infection prevention and control domains was 0.
The mean compliance was highest for the injections and blood samples domain, at 0. In the main study, the mean number of infection prevention and control indications per patient was 7.
The mean overall compliance was 0. The number of indications and safety violations increased with the number of procedures but compliance varied according to the specific procedures performed Fig. This observation is consistent with the substantial variation in compliance across domains Fig.
For example, the mean compliance in the injections and blood samples domain was 0. Infection prevention and control indications and safety violations, infection prevention and control study, Kenya, CI: A safety violation occurred when the required action was not taken.
The percentages in parenthesis give the proportion of patients who underwent the procedure or combination of procedures.
Compliance with infection prevention and control practices, by infection prevention and control domain, Kenya, CI: In the hand hygiene domain, the mean compliance was 0. The regression coefficient for the association between compliance and the availability of supplies determined using the ordinary least squares method is 0.
However, after domain fixed effects were taken into account, the regression coefficient was 0.In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about g/week.
For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped .
The Japanese word for Japan is 日本, which is pronounced Nihon or Nippon and literally means "the origin of the sun". The character nichi (日) means "sun" or "day"; hon (本) means "base" or "origin". The compound therefore means "origin of the sun" and is the source of the popular Western epithet "Land of the Rising Sun"..
The earliest record of the name Nihon appears in the Chinese.
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