Existing Health Care Delivery System Research Articles

Examining the Factors Impacting Integrated Service Delivery in Leprosy Elimination Programs in Bihar

The disease control program is critical to the agenda of social justice. A generalist approach to the disease control program involves understanding its complexity and prevention from various perspectives, including ecological theory. The integration of the disease control program into the existing healthcare delivery system has been advocated over many decades, with an emphasis on the medical model of disease control. Integration has been widely considered as a means to achieve an effective and efficient health system. This approach has been widely adopted in low-middle-income countries to integrate vertical programs such as leprosy, malaria, HIV/AIDs, and others. However, studies suggest that there is a lack of evidence about the effectiveness of health system integration. The available evidence shows that integration of the health system can have a mixed, negative, or no impact on the health system. This growing enthusiasm toward health system integration is primarily based on the perceived benefits of an integrated approach. This discussion paper draws on the experience of the integration of the National Leprosy Elimination Program in India. It highlights the factors that affected the integration of leprosy programs in Bihar and also affected the pursuit of social justice for people who have been marginalized in our modern world.

Identifying non-communicable disease multimorbidity patterns and associated factors: a latent class analysis approach

ObjectiveIn the absence of adequate nationally-representative empirical evidence on multimorbidity, the existing healthcare delivery system is not adequately oriented to cater to the growing needs of the older adult population....

Community-based decentralized mental health services are essential to prevent the epidemic turn of post-Covid mental disorders in Bangladesh: A call to action.

Community-based decentralized mental health services are essential to prevent the epidemic turn of post-Covid mental disorders in Bangladesh: A call to action.

Towards Data Driven Spatio-Temporal Threshold Identification Based on Cost Effective Public Health Information Management Framework

Appropriate public health action comes from data driven decision support systems. While sophisticated health information exchange framework may be costly in developing countries, the health care delivery system in place may provide a promising infrastructure that spans all parts in a region. Therefore, while digital and non digital data is constantly being generated from variety of sources including public and private health sectors, the health care delivery systems remain the primary and most fundamental source for data on population health status. For low and middle income countries with minimum digitization and resource constraints, traditional existing health care delivery system can be taken advantage of, for efficient production and timely transmission and utilisation of data to identify thresholds for disease outbreak in order to improve health status and health system performance. Due to lack of appropriate universally agreed criteria for threshold, defining local thresholds for infectious disease is not only crucial but also more appropriate. In this paper, we present a low cost data driven framework called Health Data Driven Framework (HDDF) through which data generated at health care facilities may be used for threshold detection and alarm generation. We also identify a localized method based on spatio-temporal mining of available data for appropriate threshold identification.

Integration of health information technology and promotion of personhood in family‐centered dementia care

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) are leading causes of disability and often result in communication deficits that can complicate ADRD caregiving and clinical care. Augmentative and Alternative Communication (AAC) devices have been shown to provide assistance in communication for persons with ADRD, although many of these devices have been criticized for limited ability to customize content or design, and not addressing the impact of communication deficits on the larger family unit. This program of research has been informed by related theoretical frameworks: person‐centered (PCT) and family‐centered theories (FCT).MethodAn interdisciplinary team working with stakeholders are designing a novel information technology prototype with a touchscreen to promote communication and personhood for persons with ADRD. This improved ACC device is best described as an AAC Plus. The AAC Plus goes beyond traditional AAC in that it can be integrated into an existing healthcare delivery system and provide real‐time clinical data and health trends to the healthcare provider for early detection, intervention, and monitoring of clinical symptoms. In addition, the AAC Plus: (1) is designed to promote engagement and communication for interactions between the caregiver and person with ADRD using ubiquitous touchscreen technology; (2) facilitates tracking of behavioral and other clinical information about the person with ADRD, such as sleep and appetite; (3) has easily customizable interfaces for the caregiver and person with ADRD.ResultUsability and feasibility will be tested using common use case scenarios, user experience testing, alpha testing, and beta testing methodologies to evaluate ease‐of‐use and cognitive ergonomics for both caregivers and persons with ADRD. This will include evaluating the design layout, user flow, and integrated content for the device’s interfaces. Once usability and feasibility is established, the team will conduct a randomized trial of the AAC Plus, in collaboration with Memory Centers in the United States (R01 AG068572‐01).ConclusionThis presentation will provide content on the process of development and human‐computer interaction methodologies used to develop an evidence‐based, innovative technology for people with ADRD and their caregivers. Attention will also be given for developing technologies for ADRD care that integrate person and family‐centered design.

Coordinated Management of COVID-19 Response: Lessons From Whole-of-Society and Whole-of-Health Strategies in Wuhan, China.

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has been challenging globally following the scarcity of medical resources after a surge in demand. As the pandemic continues, the question remains on how to accomplish more with the existing resources and improve the efficiency of existing health care delivery systems worldwide. In this study, we reviewed the experience from Wuhan - the first city to experience a COVID-19 outbreak – that has presently shown evidence for efficient and effective local control of the epidemic.Material and Methods: We performed a retrospective qualitative study based on the document analysis of COVID-19-related materials and interviews with first-line people in Wuhan.Results: We extracted two themes (the evolution of Wuhan's prevention and control strategies on COVID-19 and corresponding effectiveness) and four sub-themes (routine prevention and control period, exploration period of targeted prevention and control strategies, mature period of prevention and control strategies, and recovery period). How Wuhan combatted COVID-19 through multi-tiered and multi-sectoral collaboration, overcoming its fragmented, hospital-centered, and treatment-dominated healthcare system, was illustrated and summarized.Conclusion: Four lessons for COVID-19 prevention and control were summarized: (a) Engage the communities and primary care not only in supporting but also in screening and controlling, and retain community and primary care as among the first line of COVID-19 defense; (b) Extend and stratify the existing health care delivery system; (c) Integrate person-centered integrated care into the whole coordination; and (d) Delink the revenue relationship between doctors and patients and safeguard the free-will of physicians when treating patients.

Implementation of universal health coverage by South Korea during the COVID-19 pandemic

COVID-19 - the worst pandemic of the current century, has infected more than 80 million people, resulting in nearly two million deaths by the end of the year 2020. The pandemic has highlighted multiple issues in the existing healthcare delivery system throughout the world including racial/ethnic disparities in receipt of health care, differences in health outcomes by socio-economic and healthcare coverage status. Despite the few limitations of universal health care (UHC), including long wait times and limited usage of novel healthcare technology because of budgetary constraints [1], there are notable benefits of UHC, such as equitable health coverage for the entire population, lower cost of healthcare to society, reduced administrative costs, etc.

Complementary medicine utilization and practices of self-medication in the field practice areas of a medical college of district Dakshina Kannada, Karnataka, India

INTRODUCTION: Complementary modalities have been established globally but lack of sufficient data on their utilization patterns hinders the mainstreaming with the existing health care delivery system. The concerning issues are especially of self-medication and usage of complementary medicines with or without the usage of allopathic drugs. AIM: The study aims to find out the prevalence of complementary medicine utilization and prevalence of self-medication amongst the people in the field practice areas of the medical college. MATERIALS AND METHODS: Community-based cross-sectional study was conducted from November 2018 to January 2019. The International questionnaire for the use of Complementary and alternative systems of Medicine was used to interview the 451 study participants. The results were expressed in percentages and proportions. Chi-square test was used to find out the association of sociodemographic variables with the use of complementary medicine and self-medication practices. RESULTS: Overall prevalence of utilizing the complementary medicine services were found to be 17.7%. About 14.6% and 2.9% of the study participants visited ayurvedic and homeopathic practitioners, respectively for the past 12 months. A significantly higher proportion of the rural population was utilizing the services of the complementary system of medical practitioners. Other sociodemographic variables were not found to be associated with the utilization of complementary medicine services. The prevalence of self-medication practices was found to be 25.9%. CONCLUSION: The prevalence of complementary medicine utilization was lower than the prevalence of self-medication practices. Rural area study participants accessed more services of a complementary system of medical practitioners.

Study of mortality and morbidity patterns and various emerging non communicable diseases in the elderly

Background: The geriatric population is defined as population aged 60 years and above. The mixed profile of communicable and non-communicable diseases among the elderly population in developing countries places a huge burden on the existing health care delivery system. Present hospital based cross-sectional study was focused on the morbidity profile of the elderly and improve the health care services so as to enable them to lead a productive life. Material and Methods: Present study was single centre, descriptive observational study, conducted in subjects above 60 years and both gender, visiting to OPD and IPD, willing to participate in study after written consent. Results: We included total 200 geriatric population in our study. Majority of them were from 60-70 years age group (50 %) followed by 71-80 years (37%) and 81-90 years age group (13%). Mean age was 70.75±7.25 years. Males were 56.5% and females were 43.5%. Males were predominant in our study with male to female ratio 1.29:1. Most common addiction seen among the patients are tobacco chewing (49.5%) followed by smoking (27%), followed by pan (24.5%), nut (21.5%) and alcohol (10.5%). Family history of diabetes and hypertension was present in 63.5% and 72% cases respectively. Prevalence of cataract as commonest observed morbidity in our study was 60%, DM 37%, hypertension 34%, IHD 33.5%, anemia 21%, hearing loss 11.5% and cancer was 4%. Out of 45 deaths, 44.4% deaths occurred in patients with IHD as risk factor, 26.6% deaths occurred in patients with COPD as risk factor, 22.2% deaths occurred in patients with CVA/stroke as risk factor and 17.8% deaths occurred in patients with AKI as risk factor. So IHD, COPD, CVA and AKI were significantly associated with mortality. Conclusion: Commonly observed morbidities were cataract (60%), diabetes mellitus (37%), hypertension (34%), ischemic heart disease (33.5%) Significant association of mortality was seen with ischemic heart disease, chronic obstructive pulmonary disease, cerebrovascular accident and acute kidney injury.

'Senior Nursing Students and Interns' Concerns and Willingness to Treat Patients with COVID-19: A Strategy to Expand National Nursing Workforce during the COVID-19 Pandemic.

BackgroundThe coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.ObjectiveThis study aimed to measure senior nursing students and intern’s willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.MethodsThis quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants’ willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.ResultsOut of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants’ feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).Conclusion/RecommendationThere is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

Why women with breast cancer presented late to health care facility in North-west Ethiopia? A qualitative study.

Although early diagnosis is a key determinant factor for breast cancer survival, delay in presentation and advanced stage diagnosis are common challenges in low and middle income countries including Ethiopia. Long patient delays in presentation to health facility and advanced stage diagnosis are common features in breast cancer care in Ethiopia but the reasons for patient delays are not well explored in the country. Therefore we aimed to explore the reasons for patient delay in seeking early medical care for breast cancer in North-west Ethiopia. A qualitative study was conducted from November to December 2019 using in-depth interviews from newly diagnosed breast cancer patients in the two comprehensive specialized hospitals in North West Ethiopia. Verbal informed consent was taken from each participant before interviews. A thematic content analysis was performed using Open Code software version 4.02. Lack of knowledge and awareness about breast cancer, cultural and religious beliefs, economic hardships, lack of health care and transportation access, fear of surgical procedures and lack of trusts on medical care were the major reasons for late presentation of breast cancer identified from the patient's narratives. The reasons for late presentation of patients to seek early medical care for breast cancer had multidimensional nature in Northwest Ethiopia. Health education and promotion programs about breast cancer should be designed to increase public awareness to facilitate early detection of cases before advancement on the existing health care delivery system.

Obstetrics referrals: Maternal and perinatal outcome in medical college hospital in eastern India

Referral is essential part of maternal and child services. Major causes of referral to a tertiary center includes preterm labor, preeclampsia, eclampsia, previous CS, Rh negative blood group, antepartum hemorrhage, postpartum hemorrhage and sometimes due to lack of manual resources. To identify the primary reasons and pattern of obstetric case referral to our hospital and to study the maternal and perinatal outcome in those cases. Two Hundred obstetric referred cases of more than 28 weeks gestation admit ­ ted to IQ City Medical College, Durgapur were analyzed for the maternal and perinatal outcome. In this study of the total studied patients majority were in the group 21-25 yrs constituting about 72.09%. Of the total studied patients majority of them around 66.1 % are of Socioeconomic class III. Primigravidas constitute the majority of about 62% of the referral. Majority of the cases about 72% are booked mostly at government hospitals and only 28% of the cases are unbooked. 38.7% of the referral was from the areas like Raniganj, Bolpur, Panagarh. About 87.1% of the referral has been made with an obstetric indication. 12.6% of the referral had medical indication for referral. Only 1.3% of the cases had lack of manual resource as an indication for referral. Analyzing at the quality of referral according to the predefined criteria only 55% of the cases had adequate referral whereas about 25% of the cases had poor referral most of which were from the PHCs. 37.7% of the patients delivered vaginally, with about 62.3% of the patient delivered by caesarean section. In the present study there were a total of 131 live births, 5 still births and 7 early neonatal deaths making the perinatal mortality rate (PNMR) of 95.23 per 1000 live births, which shows a much better outcome than the other similar studies. Perinatal outcome was best for patients with age group 21-25 years and was worst for age group more than 30 years. Although better than the national data, there is indeed no doubt that rural health care infrastructure is falling short of the existing requirement. However, educating the population about the existing health care delivery system and sensitizing the public toward improving maternal and child health would go a long way in optimally utilizing the existing infrastructure and improving the maternal and perinatal outcome.

Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

Prospective study to assess knowledge, attitude and breast-feeding practices of post-natal mothers in Punjab, India

Background: According to World Health Organization WHO (2009), ‘Exclusive breastfeeding means that an infant receives only breast milk from his or her mother, or expressed breast milk and no other liquids or solids, not even water, with exception of oral rehydration solutions, drops consisting of vitamins, minerals supplements or medicines if required’. In India, breastfeeding appears to be influenced by social, cultural and economic factors. In 1991, Breastfeeding Promotion Network of India (BPNI) was formed to protect, promote and support breastfeeding. Further, the government of India has undertaken National Rural Health Mission, which intends to implement Integrated Management of Neonatal and Childhood Illness (IMNCI) through the existing healthcare delivery system. Poor practices and attitudes towards breastfeeding have been reported as major reason for poor health outcomes in developing nations.Methods:Present study is a prospective study carried out among postnatal mothers, attending OPD’s and immunization clinic, Department of Paediatrics at Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar from February 2016 till March 2017 over period of 13 months. Total of 1000 mothers were included who met with the inclusion criteria. Inclusion criteria of study were mother of healthy baby (baby weight more than 2.5 kgs), baby without any congenital defect and baby born between 37 to 42 weeks of gestation.Results: The sample of the present study comprised of postpartum mothers (N=1000), among whom 35% (n=350) belonged to 22-25-year age group and only 12.8% (128) were above age group of 31 years. Among total 1000 subjects 28% (n=28) were illiterate. 65.3% (n=653) of the mother were living in the joint family in contrast to 34.5% were having nuclear family. Among total subjects (n=1000) 18.2% were working mothers and rest 81.8% were housewives. 76.4% belonged to rural area and 23.6% to urban area. 60.4% were primigravida and 39.6% were multigravida. Among total subjects 56% delivered normally and 44% by LSCS. In present study, majority of the mothers had prior knowledge regarding importance of colostrum, the first breast milk to baby, i.e 71.8% where as 28.2% were not aware of it. 82% mothers in current study had knowledge about importance of breastfeeding while rest 18 said breastfeeding was not important.Conclusions: The present study concludes that mothers have an average knowledge about breastfeeding and poor breastfeeding practices were followed, thus, it is important to educate mother and families regarding breastfeeding and its importance, we need to strengthen public health education system to promote breastfeeding. Further focus on various factors which play important role in promotion and practices of early initiation and exclusive breastfeeding can lead to successful implementation of policies and programmes and in turn help in raising and nurturing a healthy child, a healthy youth for the nation.

Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study.

BackgroundVirtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use.ObjectiveDescriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician.MethodsThe study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs.ResultsDuring 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was “very” or “somewhat” helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can –$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can –$8.68, P<.001).ConclusionsVirtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems.

Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care

The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system.This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients.We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.

Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam.

BackgroundIntegrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest.MethodsA cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80–90 % response rate).ResultsRespondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3 % on MMT for 36–60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3 %). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8 %), anxiety/depression (43.1 %), and mobility (13.3 %). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients.ConclusionsOutcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.

Clinical profile of human immunodeficiency virus infection in children: an interesting prospective study

Background: HIV infection has become a pandemic affecting both industrialized & developing countries. The increase in pediatric HIV infection has had a substantial impact on childhood mortality both in industrialized countries and developing countries. It is believed that this study will motivate research worker to work for further improvement of the disease, clinical presentation, diagnostic measures and management in already existing health care delivery system in a tertiary care centre in the tribal area and which may lead to even better survival and quality of life for these children. With the above background, the study is taken up to find the clinical profile of HIV infection in pediatric population in the study area. Methods: The current hospital based prospective study was carried out in the department of pediatrics, Shri V. N. Government Medical College, Yavatmal (Maharashtra), India from 1st January 2011 to 30th June 2012. 108 cases of HIV attending the pediatric OPD and IPD were included in the study. Importance of test was explained to the parents. HIV was diagnosed by using Standard Protocol. All those who were positive by ELISA, confirmed it by repeat test after 3 months. Western blot was not possible due to non availability of kits. Confirmations of all infections were done as per strategies suggested by WHO. Due to non-availability of specific but expensive test like PCR, p24 antigen assay or HIV Culture, children of PPTCT positive mother were tested on follow up after 18 month age to determine whether the transmission was vertical. Results: Majority (60.18%) cases in this study are below 5 years of age. Maximum cases 33(30.55%) were between 5-10yrs of age and 5 cases (4.62%) were below 18 months. Males 69(63.88%) outnumbered females 39(36.11%) with M: F ratio of 1.76:1. In the present study predominant route of transmission of HIV to the child was by perinatal (vertical) transmission (98.15%). Maximum 64(59.25%) were home delivered cases followed by 29(26.85%) normal hospital delivered and 6(5.55%) LSCS/instrumental delivered cases. In present study 60(55.55%) severe malnutrition (Group III and IV) was the most common examination finding. Of the total 108 cases enrolled in the study, 75 cases had regular follow up for 250 times and 33 cases did not follow up. Majority of follow ups were for respiratory complaints (23.20%) and fever (17.60%). Only 7.20% patients came for follow up were asymptomatic. Most of the follow up were for OI’s. In this study, 108 cases of the study group visited 250 times in our hospital. Out of these 90 cases had 212 episodes of OI’s and 18 cases had no evidence of OI’s. Conclusions: HIV infection is an unpredictable disease in infants, children and adolescent which involves multiple organ system and is characterized by progressive clinical deterioration and ultimate development of severe immune dysfunction with opportunistic infections and secondary cancers resulting in a chronic and very complex illness. HIV infected infant and children now survive to adolescent and adulthood, and the challenges of providing HIV care are evolving into the challenges of providing both acute and chronic, lifelong care.

Optimizing chronic HIV care in the Dutch Caribbean: a questionnaire based study on experience and perception of healthcare workers.

Human immunodeficiency virus (HIV) infection has become a chronic disorder for which adaptation of current healthcare practices is needed. In Curaçao, a new organization of chronic HIV care is being set up based on task shifting in which healthcare workers (HCWs) will deliver HIV care more prominently within the primary healthcare system. In preparation for implementation of the proposed task-shifting model, we investigated the perception of HCWs regarding existing HIV care in Curaçao and the need for training in HIV/AIDS among HCWs. An in-depth questionnaire based study was used. Nineteen HCWs of seven different cadres were interviewed. The questionnaire constituted four sections: quality of existing HIV care, respondents own knowledge and willingness to be trained, need for training in HIV/AIDS and preferred educational approaches. Quality of existing HIV services in Curaçao is considered acceptable but needs improvement mainly to facilitate integration of chronic HIV care. All respondents indicated that training in HIV/AIDS is needed among HCWs in Curaçao, especially for nurses and general practitioners. All were willing to participate in training with varying amounts of time to be spent. Training should be tailored to the level of expertise of HCWs and to the role a HCW is expected to have in the new healthcare delivery framework. There is need for training to ensure the effective integration of chronic HIV care into the existing healthcare delivery system in Curaçao.There is a willingness and need in all cadres for training with e-learning as a preferred educational tool.

Analysis of the causes of maternal death in eclampsia

Objective: To analyze the causes of maternal death in eclamptic mothers. Materials and method: The study was conducted over a period of one year 1.1.2012- 31.12.2012 in all eclamptic mothers. Pregnancy was terminated in all antenatal eclampsia irrespective of gestational age. All of them were treated with Pritchard regimen of Magnesium Sulphate (MgSO4). Preeclampsia profile and special investigations were done. Sublingual/ intranasal/oral nifedipine and oral labetalol were used as antihypertensive. Results: Incidence of eclampsia was 3.57%, case fatality rate was 3.57% and maternal mortality ratio was 4.32/1000 live births. 29.76% maternal death was due to eclampsia. All 25 dead mothers were hypertensive during admission. Among them 64% (16) mothers had severe hypertension. 44% mothers had repeated convulsion. In majority (60%) MgSO4 regimen could be started after 12 hrs convulsion. 33.33% of dead mothers delivered within 12 hr of admission. 9 (42.85%) mothers died before delivery. 3 mothers came after outside delivery. 36% mothers died within 12hrs. 48% mothers died in the next 12 hrs and 16% (4) mothers died 48hrs after admission. 52.38% mothers had vaginal delivery. Only 4.7% had caesarean delivery. 40% mothers died of cerebral hemorrhage. 28% mothers died of pulmonary edema, 12% due to postpartum hemorrhage and 2 mothers due to hepatic coma. One mother died of aspiration, one mother due to septicemia. One died due to acute renal failure. Conclusion: we have a long way to go to achieve the goal to reduce the maternal mortalily due to preventable causes. We have to improve our existing health care delivery system, referral system and infrastructure before achieving the target.