Government Health Care Providers Research Articles

Caffeine addiction and determinants of caffeine consumption among health care providers: a descriptive national study.

Caffeine is the most commonly used psychostimulant compound with a long history of worldwide consumption. Consuming low to moderate doses of caffeine is generally safe and quite beneficial; however, several clinical studies show that high doses could be toxic. Additionally, caffeine users can become dependent on the drug and find themselves unable to reduce consumption despite impending and recurrent health problems associated with continued use. This study was conducted to explore the prevalence, determinants, and positive and negative effects of caffeine consumption among governmental health care providers (HCPs) who were caffeine users. It aims to determine the frequency of caffeine dependence and addiction in the Kingdom of Saudi Arabia (KSA) in January 2020. This cross-sectional study recruited 600 randomly selected HCPs from all regions of KSA, who fulfilled the selection criteria through a self-administrated, online-validated questionnaire composed of three main parts using the DSM-IV to diagnose dependence and probable addiction. The majority of the studied HCPs were females (67.8%), nonsmokers (82.0%), and Saudis (80.5%), with a mean age of 35 years. According to the DSM-IV, the prevalence of caffeine consumption was 94.3%. Caffeine dependence was reported in 270 (47.7%), while 345 (60.9%) were diagnosed as addicts. The most commonly consumed caffeine-containing substances were coffee and its variants/types (70%), tea (59%), and chocolate (52%), with each person spending about 220 SR per week on them. The main reported adverse effects, in descending order, were sleep disturbances, stomach problems, and cardiac symptoms. The most positive effects reported of caffeine consumption were feeling active, alert, confident, and happy. These findings were significantly affected by sex, occupation, and general health. Caffeine use, dependence, and addiction are common among government HCPs in KSA. Caffeine has both positive and negative effects on this population and further research is necessary to better understand the long-term consequences of caffeine consumption.

Geographic Information System enabled dengue surveillance system in south zone, Bangalore city: A pilot study

Introduction: The Public Health Information and Epidemiological Cell (PHIEC) of Bruhat Bengaluru Mahanagara Palike (BBMP) utilizes the Geographic Information System (GIS) enabled integrated surveillance for collection, integration, analysis and reporting of geo-referenced epidemiological diseases in Bangalore city. Dengue fever is an emerging disease and there are minimum studies conducted in India about the GIS enabled dengue surveillance system. Objective: To assess the relationship between dengue cases and vector indices as depicted in the GIS map. Methodology: Data regarding dengue confirmed cases was obtained from PHIEC and entomological surveillance data from Urban Primary Health Centres (UPHC) for May to July 2017 in south zone of Bangalore city and active data collection was done for August and September 2017. Results: There was significant association between the number of dengue cases and the Breteau index in the month of September. However, there was no association between vector indices and the number of cases during the month of October. In some wards, contrary findings were noted between dengue vector indices and number of cases reported. Conclusion: There was a relationship between reported dengue cases and vector indices and there is a need for incorporation of entomological data into GIS system along with epidemiological and intervention data. Involvement of more private and government health care providers may help answer the gap between entomological data and number of dengue cases.

Factors Associated with Maternal Deaths in a Hard-To-Reach Marginalized Rural Community of Bangladesh: A Cross-Sectional Study.

Every year in Bangladesh, approximately 5200 mothers die (172 maternal deaths/100,000 live births) due to maternal complications. The death rate is much higher in hard-to-reach areas and underprivileged communities, such as Bangladesh’s tea gardens. The women living in the tea garden areas are deprived of quality health care services due to inadequate knowledge, education, and access to health care services. Poverty and early marriage, followed by early pregnancy, are also triggering factors of maternal deaths in this community. This study explored the factors associated with maternal deaths in the underprivileged tea garden community in the Moulvibazar district of Bangladesh. It was a cross-sectional study conducted between January and March 2018. All maternal deaths reported by government health care providers in two sub-districts of Moulvibazar during 2017 were selected for community verbal autopsy using a structured questionnaire. Descriptive analysis was performed on quantitative data, and content analysis was performed on qualitative data. A total of 34 maternal deaths were reported in the two sub-districts in 2017, among which 15 deaths (44%) occurred in the tea garden catchment areas, where about 34% people live in the two upazilas. The majority of the mothers who died in the tea gardens delivered their babies at home (80%), many of whom also died at home (40%). Only 27% of women who died in the tea gardens received four or more antenatal care visits. Post-partum hemorrhage was found to be the leading cause of death (47%), followed by anemia (33%) and eclampsia (20%). There is a persistent high maternal mortality observed in the marginalized tea gardens, as compared to the general community of the Moulvibazar district, Bangladesh. The sustainable development goal (SDG) that has been set for maternal mortality rate (MMR) is 70/100,000 live births in Bangladesh. The findings of our study show that focused intervention is needed to reduce the burden of maternal deaths, which will improve the overall maternal health situation and also reach the SDG on time.

Pathways of antibiotic use in Bangladesh: qualitative protocol for the PAUSE study

IntroductionGlobal actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding...

Epidemiology and fatal outcomes of snakebite in the union territory of Dadra and Nagar Haveli

Background: Snakebite is one of the most neglected public health issues in the tropical and subtropical countries; India, being one of them. It is a medical emergency requiring immediate medical attention issues in poor tribal communities living in the forest area. Objectives: The indigenous factors of any geographical region are unique, and it contributes to the incidence of the snakebite and the outcome. It is necessary to consider the indigenous factors in the preventive and curative policies. The study was conducted to understand the epidemiological, geographical, and demographical aspect of snakebite in the union territory (UT) of Dadra and Nagar Haveli. Materials and Methods: Information concerning incident of venomous snakebite on weekly basis from all government health-care providers as presumptive surveillance. Furthermore, the victim’s demographic information, age, sex, addresses, biting site, and the outcome of the snakebite victims were recorded through Integrated Hospital Management System. Result: The crude incidence rate of snakebites was 21.65/10000, and annual age-standardized mortality rates per 100,000 were 1.1. The males were outnumbered on females. The male and female ratio was observed 1.4:1. Conclusion: The fatal outcomes of snakebite can be reduced in high risk area with implementation of a systematic behaviors change communication and mobilization of victims to the hospital, along with prompt administration of anti-snake venom serum (ASVS).

Challenges of NGO-to-state Referral in the Delivery of HIV Prevention Programs in Ukraine Supported by the Global Fund.

Background:Ukraine has one of the world’s fastest growing HIV rates and was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). The objective of this study was to close the gaps in the literature on the delivery of HIV prevention services by NGOs and the perceptions of NGO delivered services, using as an example HIV prevention programs in Ukraine funded by the GF.Methods:The aim of this qualitative study was to determine how NGO-based services were implemented in the context of a state-owned healthcare system of Ukraine. An ethnographic study, which included 50 participant interviews, was conducted in three oblasts in Ukraine and in the capital, Kyiv, between 2011 and 2013. This article presents some of the findings that emerged from the analysis.Results:Participants reported that NGOs were focused more on reporting numbers of rapid tests, and less on motivating clients to continue onto treatment. The role division between NGOs and the state in HIV services was largely perceived by participants as unclear and challenging. Overall, lack of clarity on the role of government healthcare providers and NGOs in providing HIV services compromised the process of finding, referring, and retaining HIV patients in care.Conclusions:Gaps in linking HIV patients to the HIV care continuum have been identified as a potentially problematic issue in delivery of HIV prevention services by GF funded NGOs. With an anticipated GF exit from Ukraine, the lack of clearly defined NGO-to-state referrals of HIV patients complicates the transition of NGO run services into state funding. Further steps to improve referral systems are necessary to ensure a smooth transition and enable Ukraine to fight its HIV epidemic effectively.

HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers.

Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China.

Lessons learned from implementing the HIV infant tracking system (HITSystem): A web-based intervention to improve early infant diagnosis in Kenya

ObjectivesGuided by the RE-AIM model, we describe preliminary data and lessons learned from multiple serial implementations of an eHealth intervention to improve early infant diagnosis (EID) of HIV in Kenya. MethodsWe describe the reach, effectiveness, adoption, implementation and maintenance of the HITSystem, an eHealth intervention that links key stakeholders to improve retention and outcomes in EID. Our target community includes mother–infant pairs utilizing EID services and government health care providers and lab personnel. We also explore our own role as program and research personnel supporting the dissemination and scale up of the HITSystem in Kenya. ResultsKey findings illustrate the importance of continual adaptation of the HITSystem interface to accommodate varied stakeholders' workflows in different settings. Surprisingly, technology capacity and internet connectivity posed minimal short-term challenges. Early and sustained ownership of the HITSystem among stakeholders proved critical to reach, effectiveness and successful adoption, implementation and maintenance. ConclusionsPreliminary data support the ability of the HITSystem to improve EID outcomes in Kenya. Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions.

Right to health in Russian Federation: identification of its current stage of constitutional and legal recognition

Russian Federation has made a strong legal commitment to the human right to health through the ratification of several key international human rights laws. Current public health care policies also demonstrate that Russian Federation has committed itself to provide the human right to health protection of people residing with its jurisdiction. All residents of Russia are eligible for medical care free of charge. Medical services are provided directly to patients by government health care providers. This includes general and specialist medical care, hospitalization, diagnostic laboratory services, dental care, maternity care and transportation, free drugs for disabled, medical rehabilitation, etc. The legal basis for the human right to health at the federal level is provided by a variety of legislative acts (codes, federal laws), presidential decrees, decisions and proposals of the government of the Russian Federation, and orders of the government and of the Ministry of Health and other ministries. The legal bas is at the regional level is provided by legislative instruments enacted by the governments of the Subjects of Russian Federation.

Perception and experiences of a tribal community on health-care provider-patient communication

Objective: The objective of this study was to assess the perception and experiences of a tribal community on health-care provider-patient communication and to find out the association between patients' place of seeking health-care and their socio-demographic characteristics. To see any differences between the government and private health-care providers in explaining treatment options and helping in their decision making. Materials and Methods: A cross-sectional study was conducted between September 2008 and February 2010 at Komlathabi area of Chandel District, Manipur. All the eligible subjects were interviewed by using a structured questionnaire. An informed verbal consent was obtained from the participants before collecting the data. Results: Out of 1947 population above 18 years, 1800 completed the interview. A total of 1679 respondents had an illness in their families in the past 1 year. Older people above 60 years, illiterate and unemployed persons went to government health center more than home/private clinic (P = 0.001) when they got sick. More than half of the respondents (58.8%) were not explained of the treatment option with benefits and risks involved. Nearly, 76.3% of the respondents perceived that they should be involved in making a decision for the treatment and nearly 64% of them felt that health-care provider should not see patients at home or private clinics. The majority of government health-care providers (70.3%) did not explain about the treatment option to their clients and also did not take patients' opinion while arriving at treatment option (66.5%), which was found to be statistically significant. Conclusion: Private health-care providers explained more to their patients about the treatment options with the benefits and risks involved, and took patient's opinion while arriving at treatment option than the government health-care providers. Therefore, it is necessary to develop a good communication skill among all the physicians, more so among public sectors.

Challenges for community role in tuberculosis response

The central role of communities in the response to tuberculosis has long been recognised by policy makers 1 WHOStop TB PartnershipThe Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals. http://www.who.int/tb/publications/2006/stop_tb_strategy.pdfDate: 2006 Google Scholar and patients 2 World Care CouncilThe patients' charter for tuberculosis care. http://www.worldcarecouncil.org/sites/default/files/PCTC_2010_en.pdfDate: 2010 Google Scholar as an ethical and pragmatic imperative for successful programmes. In many countries, especially where tuberculosis is fuelled by HIV, government health-care providers have been outstripped of their ability to cope with the levels of service delivery needed to meet targets. 3 Stop TB DepartmentWHOCommunity participation in TB care: practice and policy. http://www.stoptb.org/assets/documents/countries/acsm/community%20contribution%20to%20tb%20care.pdfDate: 2003 Google Scholar Therefore advance on the implementation of tuberculosis programmes needs broader community engagement.

Awareness and health care seeking for newborn danger signs among mothers in peri-urban Wardha

To find out awareness of mothers about newborn danger signs and their health care seeking behavior for sick newborns in the peri urban field practice area of Urban Health Centre in Wardha. Triangulated study of quantitative (survey) and qualitative (mapping, pair-wise ranking exercise) methods were undertaken. 72 identified mothers of children (0-11 months) in social mapping exercise were interviewed by trained social workers using pre-designed and pre-tested questionnaire and by paying house to house visits. The structured questionnaire covered information on newborn danger signs, health care seeking and socio-demographic information. The data was analyzed by using Epi_info software package. A pair-wise ranking exercise for assessment of preferred health care facility for sick newborn was undertaken with the group of purposively selected mothers. Out of 72 mothers, 29 (40.3%), 16 (22.2%) and 10 (13.9%) identified difficulty in breathing, poor sucking and lethargy/unconsciousness as newborn danger signs respectively. Only 7(9.7%) and 2 (2.8%) identified convulsion and hypothermia as newborn danger signs respectively. About 27 (37.5%) babies were sick during newborn period. About 11(15.3%) and 8 (11.1%) were reported to have poor sucking and difficulty in breathing respectively. All sick newborns with danger signs were taken to the doctor and only two mothers consulted faith healer for treatment. Considering the poor awareness of mothers regarding newborn danger signs, there is need for raising awareness building which required for early recognition and prompt treatment. Apart from strengthening government health facilities, the capacity of intermediate non government health care providers should be developed for newborn care.

The Development of United States Government Policy Toward Indian Health Care, 1850-1900

By 1850 the United States government already had a half century's experience providing health services to its Indian population. During the first halfof the nineteenth century, however, these services were focused primarily on containing epidemic diseases, especially smallpox. By mid-century, the rise of intemperance and venereal diseases among Indians convinced the government that more control over Indians' health was necessary. Professionally trained physicians, bolstered by advances in medical knowledge, led this interventionist effort at improving Indian health care. Government health care providers increasingly came to believe that success depended on undermining traditional lifestyles and leadership.

Healthcare use for diarrhoea and dysentery in actual and hypothetical cases, Nha Trang, Viet Nam.

To better understand healthcare use for diarrhoea and dysentery in Nha Trang, Viet Nam, qualitative interviews with community residents and dysentery case studies were conducted. Findings were supplemented by a quantitative survey which asked respondents which healthcare provider their household members would use for diarrhoea or dysentery. A clear pattern of healthcare-seeking behaviours among 433 respondents emerged. More than half of the respondents self-treated initially. Medication for initial treatment was purchased from a pharmacy or with medication stored at home. Traditional home treatments were also widely used. If no improvement occurred or the symptoms were perceived to be severe, individuals would visit a healthcare facility. Private medical practitioners are playing a steadily increasing role in the Vietnamese healthcare system. Less than a quarter of diarrhoea patients initially used government healthcare providers at commune health centres, polyclinics, and hospitals, which are the only sources of data for routine public-health statistics. Given these healthcare-use patterns, reported rates could significantly underestimate the real disease burden of dysentery and diarrhoea.