Facilities In District Research Articles

Assessment of Facility based newborn care at various health care facilities in Rajkot district

Background: India carries the single largest share (around 25-30%) of neonatal deaths in the world. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively with high coverage.Methods: A cross-sectional observational study was conducted at various health facilities of Rajkot district where facility based newborn care are created as per the guidelines under NRHM. It was conducted during August 2013 to October, 2013. The data entry was done in Microsoft Office Excel 2007 and analyzed in Epi info software from CDC Atlanta. Results: This study included total 32 health facilities including 10 Primary Health Centers (PHC) (24X7), 15 Community Health Centers (CHC), 5 Sub District Hospitals (SDH), one District Hospital (DH) and one Medical College (MC). There are a total of 36 facilities of different level available in government set up for newborn care starting from NBCC to SNCU. All (100%) of the health centers visited were equipped with NBCC for newborn care, while NBSU and SNCU for newborn care were created at only 2 (6.2%) centers respectively. Only 2 out of 10 PHC had all required equipments for NBCC. All the required equipments were available at 3 CHCs out of total 15 CHCs. All the SDH were having adequate equipment for NBCC except resuscitator & separate Digital Thermometer were not available at 2 SDH. At DH, except for Digital thermometer, all equipments were adequate. Only 1 SDH has been established for NBSU and it did not have adequate no. of radiant warmer and resuscitator. DH is lacking in all the required equipment for SNCU except for resuscitator (250 ml) and refrigerator. Out of total 101 health personnel, 68 (67.3%) have been trained for NSSK. From total 68 trained health personnel, 12 (17.7%) got the score above the cut off for resuscitation skill. Out of the trained respondents, 29 (42.7%) acquired score above cut off for routine care.Conclusion: All the PHCs, CHCs, SDHs and DH were deficient in equipments. NBSU was created in only one SDH. SNBU was created at DH and MC, but equipments were not sufficient at both centers. Health care providers involved in facility based newborn care units had poor knowledge regarding routine newborn care and also not properly trained in resuscitation.

Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers\u2019 perspectives

BackgroundHealth workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities.MethodsIn February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories.Results‘It is like rain’ was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers’ access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of ‘things going as intended’, as a sign of good quality care.ConclusionsUnpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing predictability within health services, and focusing on the experience of health workers within these, should be prioritised in order to achieve better quality of care for mothers and newborns.

Conceptualising the Factors Affecting Retention in Care of Patients on Antiretroviral Treatment in Kabwe District, Zambia, Using the Ecological Framework.

Background HIV remains a major public health challenge in Zambia. The roll-out of antiretroviral treatment (ART) has engendered new challenges in retention in care. Objective To conceptualise the factors affecting retention in care of ART patients at three primary healthcare facilities using the ecological framework. Method Qualitative data were collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in Kabwe district, Zambia, and subjected to thematic content analysis. Results Individual level barriers to retention in care included side effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma and nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long travel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were reported as community barriers to retention in care. Conclusion The ecological framework conceptualises the complex and dynamic factors affecting retention in ART care and highlights the need for multifaceted interventions that combine health education, disease management, and opportunities for income generation in a socially responsive and accountable environment.

Evaluation of Notifiable Disease Surveillance System in Centenary District, Zimbabwe, 2016

Background: Notifiable disease surveillance system (NDSS) data guides immediate action for events of public health importance. In July 2016, 12 patients suspected of typhoid were reported to Centenary District Medical Officer by phone. Following reporting, notification forms (T1) were not submitted to district, hence province did not receive district consolidated report (T2) for the notifications. This implies underreporting of notifiable diseases. Study was conducted to evaluate NDSS in Centenary district. Methods: Using updated Centres for Disease Control and Prevention (CDC) guidelines, descriptive cross sectional study was conducted among health workers sampled from all health facilities in Centenary district. Interviewer administered questionnaire and checklists were used to collect data, assess data quality and resource availability. Epi InfoTM 7 generated frequencies and proportions. Results: We interviewed 50 respondents from 13 health facilities and 64% were females. Health worker knowledge was rated low, 26% knew whom to notify and 40% knew forms are completed in triplicate. Reasons for failure to notify notifiable diseases included, unavailability of reporting forms 32% and lack of reporting guidelines 16%. Ninety-two percent were willing to participate. Four health facilities had at least six standard case definitions. The first two patients were only diagnosed at district level. NDSS information was used to procure antirabies vaccine and implement control measures. Conclusion: NDSS is useful, acceptable, unstable and not sensitive. Failure to notify was mainly due to lack of knowledge on NDSS. We recommend training of health workers and mentoring. Fifteen (IEC) case definitions and reporting guidelines were distributed to five health facilities.

Evaluation of the maternal mortality surveillance system in Mutare district, Zimbabwe, 2014-2015: a cross sectional study.

IntroductionIn Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS). A preliminary review of the MMSS data for Mutare district for the period January to June 2014 revealed that there were some discrepancies in cases notified and those captured on the T5 monthly return form. There were also delays in reporting of some maternal deaths. Poor reporting indicated shortcomings in the MMSS in Mutare district and we therefore sought to assess the performance of the maternal mortality surveillance system in Mutare district.MethodsA descriptive cross sectional study was conducted using Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. A total of 64 health workers were enrolled into the study from 19 selected health facilities in Mutare district and 32 maternal death notification forms submitted in 2014 to the provincial office were reviewed to assess the quality of information on the forms. Interviewer administered questionnaires were used to collect information from enrolled health workers, the system's attributes namely usefulness, acceptability, simplicity, stability, data quality, timeliness and completeness were assessed and a checklist was used to assess availability of resources for the implementation of the maternal mortality surveillance. We also determined the cost of reporting each maternal death in Mutare district.ResultsHalf of the study participants gave the correct definition of a maternal death. All health workers participated and were willing to continue participating in the maternal mortality surveillance. Majority of health workers, 79.7% used data generated from the surveillance system and 59.5% found it easy to implement the system. A total of 32 death notification forms were reviewed and of these, 31 forms were forwarded to the national office and all did not reach the national office on time. Average completeness of notification forms was 76.0% and 53.1% of the forms had all the necessary accompanying documents. Reporting each maternal death was estimated to cost $28.65 in Mutare district.ConclusionThe strongest components of the maternal mortality surveillance system in Mutare district were usefulness and acceptability. Timeliness and completeness were the weaker components of the system. The system was found to be simple; however, resources were not adequately available in all health facilities.

Factors related to depression symptoms among working women in Menoufia, Egypt.

Lifetime prevalence rates for any psychological disorder are higher than previously thought. Depression in the workplace may lower work productivity and increase maladjustment in daily professional life. The study aimed to investigate the prevalence of depression symptoms and the work-related risk factors in Egyptian working women. A cross-sectional study was carried out on 600 working women in family health facilities in Tala district, Menoufia governorate in 2015. Two questionnaires were used: one of them was an Arabic translated form of the questionnaire found in the Egyptian Practice Guidelines established by the Ministry of Health and population for family physicians to use in assessing the prevalence of depression symptoms. The second one was a predesigned questionnaire used to assess risk factors concerning demographic characteristics and the work environment related to depression symptoms. The prevalence rate of depression symptoms among working women was 37.5%. Multiple logistic regression analyses reveal that the following work-related factors were associated with an increased likelihood of exhibiting positive depression symptoms: work-related activities continued during home time, such as telephone calls or messages [odds ratio (OR)=5.10; 95% confidence interval (CI): 1.69-15.39], when work problems affect concentration and interactions with family (OR=148.67; 95% CI: 50.04-441.71), and difficulty with household chores (OR=6.63; 95% CI: 1.64-26.73). In addition, the following sociodemographic factors were significant: being divorced or widowed (OR=4.10; 95% CI: 2.28-7.36), no enough income (OR=2.59; 95% CI: 1.68-3.97), and rural residence (OR=1.74; 95% CI: 1.08-2.78). Reported depression symptoms were high among working women in Menoufia. Both unfavorable employment conditions and background characteristics such as being divorced/widow, low income, and rural residence were factors determining depression symptoms. It is necessary to establish preventive strategies for female workers to control the negative effect of depression in the workplace.

Use and Evaluation of Postpartum Care Services in Rural Malawi.

The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. Cross-sectional matched-pairs survey design. Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi. Data were collected using an interviewer-administered postpartum care questionnaire from the World Health Organization (WHO) Safe Motherhood Needs Assessment Questionnaires. Data analysis included univariate and multivariate statistics. Women's evaluation of postpartum care assessments received from midwives in rural health facilities prior to discharge included partial assessments of blood pressure (44%), temperature (41%), abdominal examination (50%), vaginal examination/bleeding (46%), breast examination/soreness (34%), and baby examination (77%). Only 16% of the women received all six of these postpartum clinical assessments prior to discharge, while 11% received none. Women also reported that midwives did not: introduce themselves (50%); ask if patients had questions (44%); explain what they were doing (43%); or explain what to expect after delivery (50%). Despite this, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Numbers of postpartum clinical assessments (p = .09) and overall evaluation (p = .71) did not differ between the four health facilities. The top three reasons for husbands' and wives' decisions to return for 1-week postpartum care visits were: being advised to return for care, wanted the mother to be examined, and wanted the baby to be examined. Participants stated prior negative experiences, or not perceiving a need for care (feels fine), may potentially prevent them from returning for postpartum care visits in a health facility. Most women reported they received only partial postpartum clinical assessments; thus, it is important for health facilities to address the adequacy of postpartum clinical assessments provided to women by midwives before discharge. Women returned for 1-week postpartum care visits because they were advised to return for care, and also to make sure their babies were examined. However, the principal reason why husbands permitted their wives to return for postpartum care was because they wanted their wives to be examined. Midwives need to advise all patients to return for postpartum care visits consistent with WHO or country guidelines, and continue to educate husbands and wives regarding the importance of postpartum care even when the wife feels fine. Refresher in-service trainings on postpartum care are recommended for midwives to encourage them to perform the recommended postpartum clinical assessments.

Measuring and Valuing Informal Care for Economic Evaluation of HIV/AIDS Interventions: Methods and Application in Malawi

BackgroundEconomic evaluation studies often neglect the impact of disease and ill health on the social network of people living with HIV (PLHIV) and the wider community. An important concern relates to informal care requirements which, for some diseases such as HIV/AIDS, can be substantial. ObjectivesTo measure and value informal care provided to PLHIV in Malawi. MethodsA modified diary that divided a day into natural calendar changes was used to measure informal care time. The monetary valuation was undertaken by using four approaches: opportunity cost (official minimum wage used to value caregiving time), modified opportunity cost (caregiver’s reservation wage), willingness to pay (amount of money caregiver would pay for care), and willingness to accept (amount of money caregiver would accept for providing care to someone else) approaches. Data were collected from 130 caregivers of PLHIV who were accessing antiretroviral therapy from six facilities in Phalombe district in southeast Malawi. ResultsOf the 130 caregivers, 62 (48%) provided informal care in the survey week. On average, caregivers provided care of 8 h/wk. The estimated monetary values of informal care provided per week were US $1.40 (opportunity cost), US $2.41 (modified opportunity cost), US $0.40 (willingness to pay), and US $2.07 (willingness to accept). ConclusionsExclusion of informal care commitments may be a notable limitation of many applied economic evaluations. This work demonstrates that inclusion of informal care in economic evaluations in a low-income context is feasible.

Exploring Factors Influencing Antenatal Care Visit Dropout at Government Health Facilities of Dhanusha District, Nepal

Background: High maternal mortality rate is still a major public health issue in resource poor countries. In Nepal, the regional socio-economic disparity explicitly reflects inequalities in maternal health service utilization and differences in maternal mortality rate. Only about 50% of pregnant women complete four antenatal care visits. Nearly 80% delivery is still conducted at home in absence of trained health worker among Terai/Madheshi dalits communities in Nepal. The present study intended to explore the factors influencing antenatal care visit dropout at government health facilities of Dhanusha district in Nepal. Methods: This is a descriptive cross sectional study. A total sample of 206 women who had received at least 1st ANC check up from the government health facility during March 2014 to March 2015 were selected using multistage sampling procedure. Interview method was adopted and semi-structure questionnaire was used to gather the study data. Data analysis was carried out in SPSS 20. Ethical clearance was taken from Nepal Health Research Council Ethical Review Board. Results: Out of total 206 respondents 104 (49.52%) of respondents have completed four ANC visits and 106 (50.47%) respondents have not completed four ANC visits. The study confirmed the significant association of antenatal visit dropout with respondents education (OR= 2.22, 95% CI= 1.264-3.917), economic status (OR= 2.37, 95% CI= 1.264-4.462, dissatisfaction with the health service provided at public health facilities (OR=17.48, 95% CI=8.764-34.88), dissatisfaction with the information provided during ANC visit (OR= 0.167, 95% CI=0.092-0.303) and unreceptive attitude of health worker (OR=3.766, 95% CI=2.095-6.769) as major hindering factors among respondents for not attending four ANC visit at government/public health facilities in Dhanusha district of Nepal. Conclusion: The study suggests promotion of positive attitude and behavior of health workers towards clients and building trust on government health facilities from health care provider side are equally important to increase antenatal service utilization among rural pregnant women.

Private providers' knowledge, attitudes and misconceptions related to long-acting and permanent contraceptive methods: a case study in Bangladesh

ObjectiveIn Bangladesh, use of long-acting and permanent methods of contraception (LAPMs) remains stagnant. Providers' limited knowledge and biases may be a factor. We assessed private providers' knowledge, misconceptions and general attitudes towards LAPM in two urban areas. The ultimate goal is to shape programs and interventions to overcome these obstacles and improve full method choice in Bangladesh. Study designTrained data collectors interviewed a convenience sample of 235 female doctors (obstetricians–gynecologists and general practitioners) and 150 female nurses from 194 commercial (for-profit) health care facilities in Chittagong City Corporation and Dhaka district. Data were collected on the nature of the practice, training received, knowledge about modern contraceptives and attitudes towards LAPM [including intrauterine device (IUDs), implants, female and male sterilization]. ResultsAll providers, and especially doctors, lacked adequate knowledge regarding side effects for all LAPMs, particularly female and male sterilization. Providers had misconceptions about the effectiveness and convenience of LAPMs compared to short-acting contraceptive methods. Implants and IUDs were generally perceived more negatively than other methods. The majority of providers believed that husbands favor short-acting methods rather than LAPMs and that women should not use a method that their husbands do not approve of. ConclusionsOur findings document knowledge and attitudinal barriers among private for-profit providers in urban areas affecting their provision of accurate information about LAPM choices. Practitioners should be offered the necessary tools to provide women full access to all modern methods, especially LAPMs, in order to contribute to decreasing unmet need and improving full method choice in Bangladesh.

Tackling Health System Delays for Cancer Patients in LMICs: An Innovative Multicomponent Programmatic Intervention in Botswana

Abstract 67 Background: Health system delays are a major contributor to poor outcomes among cancer patients in low- and middle-income countries (LMICs). In Botswana, while median time from cancer-related symptom onset to first presentation at local health facility is 29 days, median time to initiation of cancer treatment is 401 days. Challenges to timely diagnosis and care include clinicians' lack of knowledge, limited diagnostic capacity, poor coordination between facilities, and socioeconomic barriers of patients that impede follow-up. We sought to develop an intervention to improve access to prompt cancer care. Methods: Participating facilities are all public health facilities (21 health posts, 14 clinics, 2 hospitals) in Botswana's Kweneng-East district as well as the national referral hospital. The five components of intervention are a) training of clinicians at primary facilities on evaluation of patients with suspected cancer, b) implementation of a standardized referral algorithm for cancer suspects, c) introduction of care-coordinator role to support patient and clinician navigation of the health system, d) use of SMS-based platform to support follow-up, e) provision of transport support for vulnerable patients. The primary endpoints are stage at cancer diagnosis and time from initial presentation to initiation of cancer treatment. Evaluation of the intervention's impact will include comparing endpoints following intervention with those at baseline and those among patients residing outside the Kweneng-East district. Results: Implementation of the above multi-component intervention will be presented, including a standardized algorithm to guide the evaluation, triage and referral of patients, an intensive one-day didactic training program that adapts curricula employed in the region, and the impact of training on knowledge. Conclusion: In conducting this study, we hope to identify effective program-based measures to reduce delays and improve cancer outcomes in Botswana. These measures may be scaled to other districts, and may be applicable to similar settings in the region. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Neo M. Tapela No relationship to disclose Malebogo Pusoentsi No relationship to disclose Kerapetse Botebele No relationship to disclose Michael Peluso No relationship to disclose Isaac Nkele No relationship to disclose Jason Efstathiou Honoraria: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Consulting or Advisory Role: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Tomer Barak No relationship to disclose Scott Dryden-Peterson No relationship to disclose

The referral pathway of presumptive drug resistant tuberculosis in the urban poor areas of Metro Manila, Philippines

Background: The National Tuberculosis Control Program (NTP) guidelines emphasize that all presumptive Drug Resistant Tuberculosis (DRTB) with history of previous tuberculosis (TB) treatment and with Multi-Drug Resistant Tuberculosis (MDRTB) contacts should be screened for MDR. Due to lack of tools to identify the referral outcome of presumptive DRTB, the RJPI developed an MDRTB Presumptive Masterlist to account referrals from health center to MDR treatment center. The study aims to understand gaps in the referral pathway experienced by Local Government Units (LGUs) and Non-Government Organizations (NGOs) from initial consultation until initiation of treatment. Methods & Materials: A retrospective descriptive study of patients’ data registered on MDRTB Presumptive Masterlist of eighteen Directly Observed Treatment Short-Course (DOTS) facilities in District 1 Tondo, Manila and Payatas, Quezon City from October 2012 to September 2013, were reviewed and analyzed using structured questionnaire. Unpaired t-test used in comparing the turnaround time between LGUs and NGOs including time between Direct Sputum Smear Microscopy (DSSM) results presented to patient and referred to MDR treatment center. A p-value < 0.05 was considered statistically significant. All analysis performed using EZR with graphical user interface for R. Results: A total of 378 Presumptive DRTB was identified and listed in the masterlist. Among them, 97% (368/378) referred and 90% (333/368) screened at MDR Treatemnt center. Among screened, 85% (283/333) completed the process of MDR screening and provided with an appropriate treatment based on NTP guidelines. 9.5% (35/368) were not screened mainly due to lost to follow up. The duration of time between sample collected and examined at laboratory of NGOs was significantly longer than LGUs (n = 283; p < 0.001). The time duration between the release of DSSM results and presentation of patient at NGOs was significantly shorter than LGUs (p = 0.009). Conclusion: Development of MDRTB Presumptive Masterlist has facilitated tracking of patients due for diagnosis and treatment. Referral system between health center and MDR treatment centers should be strengthened for proper patient endorsement and provided with an appropriate action. The NGOs should lessen diagnosis delays and LGUs should follow up patient for early start of TB treatment.

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India.

Background:Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities.Objectives:This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities.Materials and Methods:A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using ‘z’ test.Results:Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years.Conclusion:Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services.

How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania.

IntroductionMaternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access.MethodsData on health facilities’ location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites.ResultsAbout half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours’ walking time.ConclusionsOur findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.

Risks associated with communication delays in infants from underserved South African communities.

BackgroundFor optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays.AimTo investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa.SettingPrimary healthcare facilities in Tshwane district, South Africa.MethodsA parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6–12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays.ResultsCommunication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18–29 years who own their house, had a 39% chance of presenting with communication delays.ConclusionDevelopmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.ContexteRisques associés à des retards de communication verbale chez les nourrissons des communautés sud-africaines non desservies.Pour s'épanouir complètement les jeunes enfants ont besoin d'un environnement chaud, réceptif, enrichi et communicatif pour apprendre le langage social et d'autres compétences. Les nourrissons et les tout-petits exposés à des risques psychosociaux souffrent d'un manque d'environnements enrichissants et pourraient souffrir de retards de communication verbale.ObjectifPour étudier la relation entre les risques psychosociaux et les retards de communication verbale chez les nourrissons des communautés non desservies en Afrique du Sud.LieuServices de soins primaires dans le district de Tshwane, en Afrique du Sud.MéthodesUne entrevue avec les parents et l'Echelle de Compétence linguistique pour les Nourrissons de Rossetti ont été utilisés pour rassembler les données de 201 nourrissons de 6 à 12 mois provenant de leurs gardiens, sélectionnés au moyen d'échantillonnages de proximité. On a remarqué un lien entre les retards et les risques de communication verbale (tests Chi carré et de Fisher). On a utilisé un modèle d'analyse log-linéaire pour modéliser l'effet simultané des risques importants sur la probabilité d'avoir des retards de communication verbale.RésultatsOn a trouvé des retards de communication verbale chez 13% des nourrissons. Les nourrissons qui vivent avec deux frères ou sœurs ou plus, nés de mères âgées de 18 à 29 ans qui ont leur propre maison, avaient 39% plus de chance d'avoir des retards de communication verbale.

Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study.

BackgroundAt least 1.4 million people are affected globally by nosocomial infections at any one time, the vast majority of these occurring in low-income countries. Most of these infections can be prevented by adopting inexpensive infection prevention and control measures such as hand washing. We assessed the implementation of infection control in health facilities and determined predictors of hand washing among healthcare workers (HCWs) in Arua district, Uganda.MethodsWe interviewed 202 HCWs that included 186 randomly selected and 16 purposively selected key informants in this cross-sectional study. We also conducted observations in 32 health facilities for compliance with infection control measures and availability of relevant supplies for their implementation. Quantitative data underwent descriptive analysis and multiple logistic regressions at 95 % confidence interval while qualitative data was coded and thematically analysed.ResultsMost respondents (95/186, 51 %) were aware of at least six of the eight major infection control measures assessed. Most facilities (93.8 %, 30/32) lacked infection control committees and adequate supplies or equipment for infection control. Respondents were more likely to wash their hands if they had prior training on infection control (AOR = 2.71, 95 % CI: 1.03–7.16), had obtained at least 11 years of formal education (AOR = 3.30, 95 % CI: 1.44–7.54) and had reported to have acquired a nosocomial infection (AOR = 2.84, 95 % CI: 1.03–7.84).ConclusionsHealthcare workers are more likely to wash their hands if they have ever suffered from a nosocomial infection, received in-service training on infection control, were educated beyond ordinary level, or knew hand washing as one of the infection control measures. The Uganda Ministry of Health should provide regular in-service training in infection control measures and adequate necessary materials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0999-4) contains supplementary material, which is available to authorized users.

Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda.

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.

Acceptance of cervical and breast cancer screening and cancer awareness among women in Villupuram, Tamil Nadu, India: A cross sectional survey

Background and objectivesCancer cervix and breast are the leading cancers of women in rural and urban India respectively. An opportunistic screening program for cancer cervix and cancer breast was initiated in Tamil Nadu, India since 2011. We estimated the acceptance of screening for cervical and breast cancer and cancer awareness among women attending primary health care facilities in Villupuram district, Tamil Nadu, India. MethodsWe did a cross sectional study among women aged ≥30 years attending PHCs in Villupuram during 2013. Sample size for the cluster design was 240 women with PHC as cluster. We collected data regarding acceptance of screening and awareness regarding cancer cervix and breast risk factors, screening and treatment using semi structured questionnaire. We computed the proportions for the acceptance and awareness related variables. ResultsWe surveyed 240 women with mean age of 44 years. Only 70 (29%) and 83 (35%) women agreed to undergo cancer cervix and cancer breast screening respectively. Overall, 167 (70%) had ever heard of cancer. The proportion of women who were aware of cancer cervix and cancer breast screening were 20% and 18% respectively. Women unaware of any risk factors of cancer cervix and breast were 81% and 85% respectively. ConclusionWe observed low acceptance of cancer screening and poor awareness regarding risk factors and treatment. There is need for awareness programs involving mass media and community health workers and increased emphasis on counseling prior to the screening to allay the fears and to address the misperceptions.

Satisfaction of medical staff in primary health care of Sumadija district

Objective. The aim of this study was to evaluate different aspects of job satisfaction among employees as well as to evaluate the overall job satisfaction in health care institutions of the primary health care level in Sumadija district. Methods. Employee satisfaction survey was conducted in 10 primary health facilities in Sumadija district. We conducted a one-day survey of 1273 employees, using a uniform, anonymous questionnaire developed by the Ministry of Health of the Republic of Serbia within the program of improvement of the quality of health care facilities. Results. The data we obtained show that a little less than a half of the employees in healthcare institutions of the Republic of Serbia were satisfied with the work they performed. The results of logistic regression showed that, among the factors examined, the following had a statistically significant impact on the assessment of job satisfaction: adequacy of work equipment, possibility of professional development, support by superiors, comparison of satisfaction of 5 years ago and now. Conclusion. Job-related experience and satisfaction of the employees indicate the need for placement of employee satisfaction as a priority in the process of improving the quality of the health care system.

Damage to agricultural facilities

The 2011 off the Pacific Coast of Tohoku Earthquake severely damaged agricultural facilities in Tohoku district, damaged coastal dikes and farmland behind the embankment, and disrupted lifelines, such as irrigation systems, in districts far from the coastline.This report introduces an outline of the damaged agricultural facilities on the basis of the investigations made during inspection visits to those facilities by National Institute for Rural Engineering (NIRE). In Fukushima Prefecture, many small earth dams, other dams, and pipelines were damaged. Among a total of 3730 dams and small earth dams in Fukushima Prefecture, 745 small earth dams were damaged by sliding failure or settlement of embankment. Small earth dams at 3 locations were breached, inflicting severe damage on the regions downstream.The embankments of two dams for agricultural use, the Nishigo dam and the Hatori dam, located in the Tohoku region, were damaged. In parts of Fukushima Prefecture where trunk pipelines for agricultural use have a total length of 17.8km, at 7 places pipelines were either exposed or experienced leakages, and severe deformation which did not satisfy standard values was noted at 149 locations.This paper reports the state of damage typical to each type of facility and the restoration measures that were undertaken.