Care Card Research Articles

Intermittent Preventive Treatment of Malaria in Pregnancy Coverage Estimates from Population-based Surveys: Reliability of Women's Recall Among Women with ANC Cards.

ABSTRACT.Large household surveys performed to estimate coverage rates for various health interventions, including intermittent preventive treatment, depend on recall. Many studies question the validity of recalled data. Regarding vaccine coverage rates, it is standard practice to validate responses using medical history cards. To validate the coverage rates of intermittent preventive treatment during pregnancy reported by large household surveys, recalled coverage rates were compared with antenatal care card data in Benin, Ghana, Malawi, and Tanzania. The results indicated that recall was comparable to the coverage rates provided indicated by the antenatal care cards. These findings suggest that intermittent preventive treatment coverage rates reported by large household surveys performed using recalled data are valid.

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EMBRACE intervention to improve the continuum of care in maternal and newborn health in Ghana: The RE-AIM framework-based evaluation.

BackgroundImproving maternal and newborn health remains one of the most critical public health challenges, particularly in low- and lower-middle-income countries. To overcome this challenge, interventions to improve the continuum of care based on real-world settings need to be provided. The Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Team conducted a unique intervention program involving over 21 000 women to improve the continuum of care, thereby demonstrating an intervention program’s effectiveness in a real-world setting. This study evaluates the implementation process of the EMBRACE intervention program based on the RE-AIM framework.MethodsA cluster-randomized controlled trial was conducted in 32 sub-district-based clusters in Ghana. Interventions comprised of four components, and to evaluate the implementation process, we conducted baseline and endline questionnaire surveys for women who gave birth and lived in the study site. The key informant interviews of health workers and intervention monitoring were conducted at the health facilities in the intervention area. The data were analyzed using 34 components of the RE-AIM framework and classified under five general criteria (Reach, Effectiveness, Adoption, Implementation, and Maintenance).ResultsIn total, 1480 and 1490 women participated in the baseline and endline questionnaire survey, respectively. In the intervention area, 83.8% of women participated (reach). The completion rate of the continuum of care increased from 7.5% to 47.1%. Newborns who had danger signs immediately after birth decreased after the intervention (relative risk = 0.82, 95% confidence interval = 0.68-0.99) (effectiveness). In the intervention area, 94% of all health facilities participated. Mothers willing to use their continuum of care cards in future pregnancies reached 87% (adoption). Supervision and manual use resolved the logistical and human resource challenges identified initially (implementation). The government included the continuum of care measures in their routine program and developed a new Maternal and Child Health Record Book, which was successfully disseminated nationwide (maintenance).ConclusionsFollowing the RE-AIM framework evaluation, the EMBRACE intervention program was considered effective and as having great potential for scaling across in real-world settings, especially where the continuum of care needs to be improved.Trial registrationISRCTN 90618993.

Prevalence of Undescended Testis in Tehran and the Main Risk Factors: A Cross-sectional Multicenter Study

Background: Undescended testis (UDT) is the most common abnormality of the male genital system. To date, no study has been carried out to determine the prevalence of UDT and its risk factors in Tehran. This study aimed to determine the frequency of cryptorchidism and its risk factors in male infants who were born at three university hospitals in Tehran. Methods: A cross-sectional study was done on boys born at three major university hospitals (Baharlou, Yas, and Ziaeian Hospitals) in Tehran between 2016 and 2018. All of the newborns were examined on the first or second day of birth. Demographic data were collected using hospital databases after getting permission. Also, the pregnancy care card was used to collect maternal complications of pregnancy, including gestational diabetes mellitus, preeclampsia, eclampsia, fetal malignancy, preterm, and late delivery. Results: A total of 1,350 boys were evaluated. Eleven (0.81%) boys had UDT. There were statistically significant associations between UDT and maternal hypertension, presence of other congenital anomalies, infection during pregnancy, fetal presentation, and type of delivery. The average birth weight and gestational age were lower in patients with UDT than in healthy infants. Conclusions: The prevalence of UDT in Tehran was much lower than in previously reported rates in other areas. Factor analysis showed that cryptorchidism was associated with the markers of poor fetal development.

Comparison of Hematological and Biochemical Profile Changes in Pre- and Post-Chemotherapy Treatment of Cancer Patients Attended at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia 2019: A Retrospective Cohort Study.

PurposeThis study aims to compare hematological and biochemical profile changes in pre- and post-chemotherapy among cancer patients admitted at the Oncology Unit of Ayder Comprehensive Specialized Hospital (ACSH), Mekelle, Northern Ethiopia.Patients and MethodsA retrospective cohort study was conducted in 376 cancer patients admitted in the Oncology Unit at ACSH. Demographic data, hematological and biochemical profiles were collected from smart care and patient cards. The data were analyzed using SPSS version 20 statistical package. Descriptive statistics and paired sample students T-test statistical methods were used.ResultsFrom 376 study subjects, 228 (60.6%) were females. All the hematological profiles, except lymphocyte (LYM) (P > 0.05), showed significant decrement in post-chemotherapy compared to pre-chemotherapy; white blood cell (WBC) (P < 0.01), red blood cell (RBC) (P < 0.01), hemoglobin (Hb) (P<0.001), hematocrit (HCT) (P < 0.05), platelet (PLT) (P < 0.001) and neutrophil (NUT) (P < 0.05). The biochemical profiles showed that blood urea nitrogen and creatinine levels were non-significantly decreased, urea (P > 0.05) and creatinine (CR) (P > 0.05), in post-chemotherapy compared to pre-chemotherapy whereas alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were non significantly increased, ALT (P > 0.05) and AST (P> 0. 05), in post-chemotherapy compared to pre-chemotherapy.ConclusionHematological profiles, except lymphocytes, were found significantly decreased whereas biochemical profiles, urea, and creatinine were decreased non-significantly, while AST and ALT showed non-significant increments in post-chemotherapy compared to pre-chemotherapy.

Low proportion of women who came knowing their HIV status at first antenatal care visit, Uganda, 2012\u20132016: a descriptive analysis of surveillance data

BackgroundHIV testing is the cornerstone for HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). Knowledge of HIV status is associated with better reproductive health choices and outcomes for the infant’s HIV status. We analyzed trends in known current HIV status among pregnant women attending the first antenatal care (ANC) visit in Uganda, 2012–2016.MethodsWe conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC visit during 2012–2016. Women who brought documented HIV negative test result within the previous 4 weeks at the first ANC visit or an HIV positive test result and/or own HIV care card were considered as knowing their HIV status.We calculated proportions of women with known current HIV status at first ANC visit, and described linear trends both nationally and regionally. We tested statistical significance of the trend using modified Poisson regression with generalized linear models. For known HIV positive status, we only analyzed data for years 2015–2016 because this is when this data became available.ResultsThere was no significant difference in the number of women that attended first ANC visits over years 2012–2016. The proportion of women that came with known HIV status increased from 4.4% in 2012 to 6.9% in 2016 and this increase was statistically significant (p < 0.001). Most regions had an increase in trend except the West Nile and Mid-Eastern (p < 0.001). The proportion of women that came knowing their HIV positive status at first ANC visit was slightly higher than that of women that were newly tested HIV positive at first ANC visit in 2015 and 2016.ConclusionAlthough the gap in women that come at first ANC visit without knowing their HIV positive status might be reducing, a large proportion of women who were infected with HIV did not know their status before the first ANC visit indicating a major public health gap. We recommend advocacy for early ANC attendance and hence timely HIV testing and innovations to promptly identify HIV positive women of reproductive age so that timely PMTCT interventions can be made.

Mind the (Tax) Gap! It is Bigger and More Complex than You Think

Historically, national revenue agencies have relied largely on trends in aggregate revenue collections along with reporting on compliance yields as the central element of their performance reporting, together with a few efficiency-related measures. Generally, trends of increasing revenue collections (ahead of budget) and rising compliance program outputs have been seen as indicators of a successful revenue agency and a healthier tax system. But is this necessarily the case? Do such indicators properly and adequately reflect the health of the tax system? In an effort to answer these questions, a relatively small but growing number of national tax agencies have over the last decade or so sought to better understand the health of their tax system by turning their attention to the concept of the ‘tax gap’— the difference between the estimated amount of tax legally payable for each tax administered and what is actually collected in practice. This interest has brought a focus to better understanding tax gap estimation methods, the introduction of comprehensive tax gap research programs, and the public dissemination of tax gap findings to increase community awareness and draw attention to the fact the revenue agency is serious about the tax gap as a long-term performance measure. This development constitutes a new frontier in the management of government revenue systems. And as these agencies often have administrative responsibility for more than just taxes (e.g. student loan repayments and superannuation contributions), these tax gap estimates can have implications beyond just taxes. In the case of the individuals income tax, this must also mean that related tax gap estimates pose a frontier challenge to government agencies administering income-related transfers (e.g. pensions and unemployment benefits) and service entitlements (e.g. health care cards). This paper builds on recent tax gap research findings published by the Australian Taxation Office (ATO) and examines what they mean for the main types of individuals income tax non-compliance, the main perpetrators, the behaviours underlying this non-compliance, and possible policy and administrative responses. The analysis is made by allocating the ATO’s individuals income tax gap estimates to its 2% individuals sample file of taxpayers in 2016-17 and reviewing the results by sources of tax gap and how they differ across various socio-economic and demographic groupings. The paper also examines what these results might mean for the repayment of income-contingent Study and Training Support Loans (STSL) and for the payment of means-tested government transfers. Finally, the paper presents a menu of potential reforms to address key weaknesses in individuals income tax policy design and administration.

Barriers in Utilization of Public Health Services by Elderly Slum Dwellers in Jaipur City

Background: Slum population in India is increasing with urbanization and even after various efforts ofGovernment and NGOs, slum dwellers remains deprived of basic services for quality of life. Getting healthservices by elderly slum dwellers is also a challenging task.Objective: The aim of this study was to find out the major barrier perceived by elderly slum dwellers inutilization of Health services. Methodology: 125 elderly aged 60 and above were randomly selected fromJawahar Nagar Urban slum of Jaipur, Rajasthan. Structured interview schedules were developed, field testedand used to interview elderly slum dwellers. Result: 84% of the elderly respondents were aware of thenearby government health facilities; data indicates that unaware elderly did not access any public health carefacility. unawareness is a barrier in accessibility of health services. 78.26 percent elderly were aware aboutthe free treatment facility available at government health centers but unaware elderly have not accessed anypublic health care facility. It was found that maximum waiting time of more than 60 minutes was for thosewho visited public hospital. 77.6% elderly did not have free health care card mostly due to unawareness.Other barriers to access of health care were Behavior of service providers (88.3%), Distance from home(64.7%), Transport facility (82.4%), Amenities at the health facility (88.3%) and Convenience for attendants(88.3%).Conclusions: Major barrier identified by elderly slum dwellers in utilization of Health services areAvailability of service provider, cost, timeliness, ease of access, behavior of service provider and coveragethrough insurance or beneficiary schemes.

Evaluation of the quality of prenatal care based on the recommendations Prenatal and Birth Humanization Program.

The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study aimed to analyze the quality of prenatal care in Sergipe based on the PHPN recommendations. This is a cross-sectional study, with a descriptive and analytic approach, using survey data from the Birth in Sergipe research, conducted from June 2015 to April 2016 with 768 puerperae proportionally distributed among all state maternity hospitals (n = 11). Data were collected from face-to-face interviews and patients' prenatal care cards. The results showed a high coverage of prenatal care (99.3%; n =763), but little more than half of these women started their prenatal care within 16 weeks of gestation (57%; n =435), and 74.7% (n = 570) had six or more visits. We noted that 16.6% (n = 127) of pregnant women were at high risk for complications and almost half continued monitoring prenatal care with professional nurses. Around 61.3% were advised about the maternity care service of reference for delivery, and 29.4% sought more than one health service for childbirth. We concluded that there was a high prenatal care coverage in Sergipe, however, with issues concerning its adaptation to the PHPN.

Analysis of Demographic Characteristics of Patients Admitted to the Emergency Department with Rabies Risk

Amaç: Bu üç yıllık çalışmamızda acil servisimize başvuran kuduz riskli temas olgularının demografik özelliklerini değerlendirmeyi amaçladık.Gereç ve Yöntem: 2012-2014 yılları arasında kuduz riskli temas nedeniyle acil servisimize başvuran hastaların demografik özellikleri hastane otomasyon sistemi, acil hasta bakı kartları ve kuduz bildirim defterinden geriye dönük olarak incelendi. Elde edilen verilerin istatistiksel analizinde SPSS 21.0 paket programı kullanıldı.Bulgular: Çalışmaya 2732 hasta dâhil edildi. Hastaların %70,4’ü (n:1923) erkek, %29,6’sı (n:809) kadın ve ortalama yaşı 23,65 yıl (min: 0, maks: 87 yıl) idi. Hastaların %15,7’sinin 2012 yılında, %39,3’ünün 2013 yılında, %44,9’unun ise 2014 yılı içinde acil servise başvurduğu belirlendi. Başvurular en sık mayıs, haziran ve temmuz aylarında idi. En sık kuduz şüphesi olan hastalarda köpeklerle (%61,6) ve ısırılma yoluyla (%71,8) temas öyküsü mevcuttu. Hastaların %95,5’ine yara bakımı ve tetanoz profilaksisi uygulanmıştır. Hastaların %99,9’una 1 doz, %85,6’sına 2 doz, %51,5’ine 3 doz, %9,9’una 4 doz ve %6,2’sine 5 doz aşı, %7,9’una kuduz aşısıyla birlikte HRIG yapıldığı saptandı. Hayvanların %99,7’sinin takip süresince yaşadığı, %0,3’ünün ise öldüğü tespit edildi. Hiçbir hastamızda kuduz hastalığı belirtileri ve ölüm görülmedi.Sonuç: Bu çalışma ile kuduz şüpheli hayvanla temasın her geçen yıl artış gösterdiği ve ilimiz için halen ciddi bir halk sağlığı sorunu olduğu belirlendi. Belediyelerce yürütülen sahipsiz hayvan toplama, kontrol ve ıslah hizmetlerine daha fazla önem verilmesi, hayvan barınaklarının kapasite ve sayılarının arttırılması, toplumun kuduz hastalığı açısından bilgilendirilmesi gerekmektedir.

Characteristics and Circumstances of Falls in the Community-Dwelling Older Adult Population.

Objective: The study aimed to describe the characteristics and circumstances of falls in the community-dwelling older adult population. Design: This was a cross-sectional observational and descriptive study involving primary health care centers in Lleida and Castellón de la Plana, Spain. Randomized sampling was used to include 966 individuals aged 75 years or older residing in single-family homes and in possession of a health care card. Data were obtained using the Survey on Fragility in Older People in Lleida (FRALLE survey). Study variables included the occurrence of falls in the past year and fall characteristics such as whether it was a first or successive fall, cause, season, and time of the day the fall occurred, whether the respondent fell flat on the ground, and time the participant remained on the floor. Other variables involved the circumstances of the fall, including the general location of the fall and specific location within the home if applicable, lighting/weather conditions, objects which may have precipitated the fall, floor conditions, and type of footwear. Results: The prevalence of falls was 25.9% with regard to the previous year, with 70% of these participants reporting having fallen previously. Falls most often occurred by accident, during the daytime, and in the winter. Variables that showed statistical significance with regard to age group were: falling flat on the ground (P = .031), fall location (P = .000), presence of an object favoring the fall (P = .039), floor conditions (P = .011), and type of footwear (P = .029). By sex, variables that showed statistical significance included the need for assistance to get up (P = .045) and type of footwear (P = .028). Conclusions: The prevalence of falls was found to be similar in the studied cities. The results show the most common characteristics and circumstances of falls in older adults in the community, making it possible to guide future preventive strategies.

Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil

BackgroundStudies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil.MethodsIn a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests.ResultsThe self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector.ConclusionsSelf-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

379. Clinical Management of HIV-associated Pneumocystis jirovecii Pneumonia in Rural Nigerian Communities: Public Health Interventions and Impact

BackgroundThe prevalence of Pneumocystis jirovecii Pneumonia (PJP) is increasing among vulnerable Persons Living with HIV (PLWH) in rural communities. In such communities, optimum clinical management of PJP in PLWH, is often limited by sub-optimal coordination of healthcare programs and inadequate human resources. The study evaluated the impact of interventions implemented by public health programs, to improve the clinical management of PJP among PLWH in rural Nigerian communities.MethodsThe longitudinal study was done at 30 randomly selected rural communities in Nigeria. Program interventions included: decentralization of comprehensive Anti-Retroviral Therapy (ART) to primary healthcare facilities; and strategic private–public partnerships to ensure provision of free medications for ART and prophylaxis/treatment of PJP, (according to National Treatment Guidelines). Additional interventions included: training of indigenous healthcare workers on clinical management of PJP; task-shifting; routine monitoring and evaluation of PJP indicators to ensure program quality, among others. Real-time data from Patients’ Care Cards were utilized for pre- and post-intervention assessments in January 2014 and January 2019, respectively. Chi-square was applied as inferential statistics; P < 0.05 indicated statistical significance.ResultsThe number of PLWH on ART, who received primary PJP prophylaxis with Trimethoprim-Sulfamethoxazole (TMP-SMX), increased from 2,280 (pre-intervention) to 14,461 (post-intervention). PLWH (55 females; 40 males), exhibited TMP-SMX intolerance and were offered Dapsone for primary PJP prophylaxis. PJP diagnosis and treatment for female PLWH increased from 5% (pre-intervention), to 82% (post-intervention). PJP diagnosis and treatment for male PLWH increased from 3% (pre-intervention), to 79% (post-intervention). Incidences of PJP increased with age, viral load, ART interruption, and late presentation to HIV care. Secondary PJP prophylaxis for PLWH (after the completion of pneumonia treatment) increased from 2% (pre-intervention) to 90% (post-intervention).ConclusionThe interventions significantly improved the clinical management of PJP in PLWH. They are recommended for implementation by health programs in rural communities.Disclosures All authors: No reported disclosures.

The advanced care coordination program: a protocol for improving transitions of care for dual-use veterans from community emergency departments back to the Veterans Health Administration (VA) primary care

BackgroundVeterans who access both the Veterans Health Administration (VA) and non-VA health care systems require effective care coordination to avoid adverse health care outcomes. These dual-use Veterans have diverse and complex needs. Gaps in transitions of care between VA and non-VA systems are common. The Advanced Care Coordination (ACC) quality improvement program aims to address these gaps by implementing a comprehensive longitudinal care coordination intervention with a focus on Veterans’ social determinants of health (SDOH) to facilitate Veterans’ transitions of care back to the Eastern Colorado Health Care System (ECHCS) for follow-up care.MethodsThe ACC program is an ongoing quality improvement study that will enroll dual-use Veterans after discharge from non-VA emergency department (EDs), and will provide Veterans with social worker-led longitudinal care coordination addressing SDOH and providing linkage to resources. The ACC social worker will complete biopsychosocial assessments to identify Veteran needs, conduct regular in-person and phone visits, and connect Veterans back to their VA care teams.We will identify non-VA EDs in the Denver, Colorado metro area that will provide the most effective partnership based on location and Veteran need. Veterans will be enrolled into the ACC program when they visit one of our selected non-VA EDs without being hospitalized. We will develop a program database to allow for continuous evaluation. Continuing education and outreach including the development of a resource guide, Veteran Care Cards, and program newsletters will generate program buy-in and bridge communication. We will evaluate our program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, supported by the Practical, Robust Implementation and Sustainability Model, Theoretical Domains Framework, and process mapping.DiscussionThe ACC program will improve care coordination for dual-use Veterans by implementing social-work led longitudinal care coordination addressing Veterans’ SDOH. This intervention will provide an essential service for effective care coordination.

Influence in the reproductive planning and the women's satisfaction with the discovery of being pregnant in the quality of prenatal care in Brazil

Abstract Objectives: to analyze the influence on reproductive planning and the women's satisfaction with the discovery of being pregnant in prenatal care characteristics. Methods: a cross-sectional and quantitative study was carried out between March and July 2018 at a low-risk maternity hospital in the Brazilian Northeast region. A total of 652 puerperal women were evaluated in an interview and by their prenatal care card. The Chi-square test and the Odds Ratio were used for statistical analysis. Results: the pregnancy planning was reported by 42% (n=274), and the women's satisfaction of being pregnant was 64.1% (n=418) of the interviewees. Reproductive planning was associated with early initiation of prenatal care (OR=2.48, CI95%=1.61-3.82) and the women received information about the referral maternity for childbirth (OR=1.44, CI95%=1.05-1.99). The women's satisfaction with their pregnancy was also associated with early initiation of prenatal care (OR=2.18; CI95%=1.47-3.25). It should be noted that the performance of six or more prenatal care consultations was less frequent among pregnant women who had not planned their pregnancy (OR=0.43, CI95%=0.27-0.66) and they felt unsatisfied with the discovery of being pregnant (OR=0.56; CI95%=0.37-0.84). Conclusions: Pregnancy planning and women's satisfaction with the discovery of being pregnant favors the performance of prenatal care with better indicators.

Predicting patient use of general practice services in Australia: models developed using national cross-sectional survey data

BackgroundThe ageing population and increasing prevalence of multimorbidity place greater resource demands on the health systems internationally. Accurate prediction of general practice (GP) services is important for health workforce planning. The aim of this research was to develop a parsimonious model that predicts patient visit rates to general practice.MethodsBetween 2012 and 2016, 1449 randomly selected Australian GPs recorded GP-patient encounter details for 43,501 patients in sub-studies of the Bettering the Evaluation and Care of Health (BEACH) program. Details included patient characteristics, all diagnosed chronic conditions per patient and the number of GP visits for each patient in previous 12 months. BEACH has a single stage cluster design. Survey procedures in SAS version 9.3 (SAS Inc., Cary, NC, USA) were used to account for the effect of this clustering. Models predicting patient GP visit rates were tested. R-square value was used to measure how well each model predicts GP attendance. An adjusted R-square was calculated for all models with more than one explanatory variable. Statistically insignificant variables were removed through backwards elimination. Due to the large sample size, p < 0.01 rather than p < 0.05 was used as level of significance.ResultsNumber of diagnosed chronic conditions alone accounted for 25.48% of variance (R-square) in number of visits in previous year. The final parsimonious model accounted for 27.58% of variance and estimated that each year: female patients had 0.52 more visits; Commonwealth Concessional Health Care Card holders had 1.06 more visits; for each chronic condition patients made 1.06 more visits; and visit rate initially decreased with age before increasing exponentially.ConclusionsNumber of diagnosed chronic conditions was the best individual predictor of the number of GP visits. Adding patient age, sex and concession card status explained significantly more variance. This model will assist health care planning by providing an accurate prediction of patient use of GP services.

Audit of the patient-carried antenatal card, South Africa

Background: In South Africa, an antenatal care card is carried by all women to appointments. This cards allows health professionals to document medical and obstetric characteristics so that important medical information can be transferred. Aims: To audit completeness and management of the antenatal care cards against maternity guidelines. Methods: A retrospective study in which 300 cards were audited in September 2015. Information audited included clinical factors, education, ultrasound, results, referral, and treatment. A composite assessment with a score of between 0 and 100% of certain aspects was made. Findings: No cards were complete. Birthweight was often recorded as ‘big or ‘average’, rather than the exact weight. ‘Planned’ pregnancy was noted in 1 card, and obstetric history was complete in 60.5% cases. Overall, 14 (8.9%) of the 157 ultrasounds were in the first trimester. Education in pregnancy was poorly documented. Clinical examination was recorded in 95% of cards. Conclusions: The card was found to be incomplete in ways that may affect maternal and fetal outcomes

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities.

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.

2.11-P24A personal health care card for asylum seekers in Norway

2.11-P24A personal health care card for asylum seekers in Norway

Factors associated with HIV positive sero-status among exposed infants attending care at health facilities: a cross sectional study in rural Uganda

BackgroundEast and South Africa contributes 59% of all pediatric HIV infections globally. In Uganda, HIV prevalence among HIV exposed infants was estimated at 5.3% in 2014. Understanding the remaining bottlenecks to elimination of mother-to-child transmission (eMTCT) is critical to accelerating efforts towards eMTCT. This study determined factors associated with HIV positive sero-status among exposed infants attending mother-baby care clinics in rural Kasese so as to inform enhancement of interventions to further reduce MTCT.MethodsThis was a cross-sectional mixed methods study. Quantitative data was derived from routine service data from the mother’s HIV care card and exposed infant clinical chart. Key informant interviews were conducted with health workers and in-depth interviews with HIV infected mothers. Quantitative data was analyzed using Stata version 12. Logistic regression was used to determine factors associated with HIV sero-status. Latent content analysis was used to analyse qualitative data.ResultsOverall, 32 of the 493 exposed infants (6.5%) were HIV infected. Infants who did not receive ART prophylaxis at birth (AOR = 4.9, 95% CI: 1.901–13.051, p=0.001) and those delivered outside of a health facility (AOR = 5.1, 95% CI: 1.038 – 24.742, p = 0.045) were five times more likely to be HIV infected than those who received prophylaxis and those delivered in health facilities, respectively. Based on the qualitative findings, health system factors affecting eMTCT were long waiting time, understaffing, weak community follow up system, stock outs of Neverapine syrup and lack of HIV testing kits.ConclusionIncreasing facility based deliveries and addressing underlying health system challenges related to staffing and availability of the required commodities may further accelerate eMTCT.