Health Centre Level Research Articles

Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care.

While team training is associated with improved hospital-based team climate, less is known about effects in the ambulatory setting. In 2014 and 2015, we enrolled 20 organizations, each operating various health centers, into this ongoing study. Evaluation tools include a communication behaviors assessment (CBA) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS® ) Teamwork Perceptions Questionnaire (T-TPQ), which staff completes at baseline, 6 months, and 1year, and the Patients' Insights and Views of Teamwork (PIVOT) survey, which patients complete at baseline and 1year. We also assessed patient satisfaction. We analyzed T-TPQs paired at the individual level and CBAs and PIVOTs paired at the health center level. We also conducted key informant interviews with the first cohort. CBAs showed that TeamSTEPPS tools and strategies were utilized, with 50% or more of centers reporting increases in all behaviors at 1year; key informant interviews confirmed this. T-TPQ findings indicated that TeamSTEPPS implementation was associated with improved staff perceptions of teamwork at 6 months; lesser improvements were seen at 1year. The PIVOT survey demonstrated significant improvements in select patient ratings of teamwork. Patient satisfaction improved at 1year. TeamSTEPPS has positive effects in the ambulatory reproductive health care environment. Improvements persisted at 1year.

Human rabies in Côte d'Ivoire 2014-2016: Results following reinforcements to rabies surveillance.

In Côte d’Ivoire, rabies is endemic and remains largely uncontrolled. The numbers of human exposures and rabies cases are unknown and are probably much higher than reported. Data on human rabies cases are collected by the National Institute of Public Health (NIPH) Anti-rabies Center in Abidjan through a network of 28 NIPH local units, which cover the population of the entire country. During 2014, the NIPH initiated a program to reinforce the human rabies surveillance system in those 28 NIPH local units, with specific goals of improving the infrastructure, training, communication, and government involvement. Here, we report the progress and findings during 2014–2016. The reinforced system recorded 50 cases of human rabies (15–18 cases/year; annual incidence = 0.06−0.08 per 100,000) and more than 30,000 animal exposures (annual incidence = 41.8−48.0 per 100,000). Almost one-half of the human rabies cases were in children ≤15 years old. All were fatal and dog bites were the most common route by which rabies virus was transmitted. In the 32 cases where samples of sufficient quality for analysis were available, rabies was confirmed by reverse transcription-polymerase chain reaction RT-PCR. Post-exposure prophylaxis with rabies vaccine was administered to all animal exposure victims presenting at the NIPH local units, although only about 57% completed the full immunization schedule. All available reports were provided by the NIPH local units, indicating effective communication between them and the NIPH Anti-rabies Center. These findings indicate that the reinforcements resulted in highly specific detection of human rabies, provided detailed epidemiological data about these cases, and improved estimates of animal exposure numbers. These represent substantial advances, but further improvements to the surveillance system are needed to increase disease awareness and capture cases that are currently missed by the system. In the future, better communication between local health centers and the NIPH units, surveillance at the local health center level, and increased veterinarian engagement will help provide a more complete picture of the rabies burden in Côte d’Ivoire.

Policy, paperwork and ‘postographs’: Global indicators and maternity care documentation in rural Burkina Faso

Targets and indicators set at the global level are powerful tools that govern health systems in low-income countries. Skilled birth attendance at a health facility is an important indicator for monitoring maternal mortality reduction worldwide. This paper examines how health workers negotiate policy implementation through the translation of clinical care into registries and reports. It does so by analysing the links between the global policy of institutional births and the role of documentation in the provision of birth care in primary health centres in Burkina Faso. Observations of health workers' practices in four primary maternity units (one urban, one semi-urban and two rural) conducted over a 12-week period in 2011–2012 are analysed alongside 14 in-depth interviews with midwives and other health workers. The findings uncover the magnitude of reporting demands that health workers experience and the pressure placed on them to provide the ‘right’ results, in line with global policy objectives. The paper describes the way in which they document inaccurate accounts, for example by completing the labour surveillance tool partograph after birth, thus transforming it into a ‘postograph’, to adhere to the expectations of health district officers. We argue that the drive for the ‘right’ numbers might encourage inaccurate reporting practices and it can feed into policies that are incapable of addressing the realities experienced by frontline health workers and patients. The focus on producing indicators of good care can divert attention from actual care, with profound implications for accountability at the health centre level.

Evaluation of the national policy of single screening and treatment for the prevention of malaria in pregnancy in two districts in Eastern Indonesia: health provider perceptions

BackgroundMalaria in pregnancy has devastating consequences for both the expectant mother and baby. Annually, 88.2 (70%) of the 125.2 million pregnancies in malaria endemic regions occur in the Asia–Pacific region. The control of malaria in pregnancy in most of Asia relies on passive case detection and prevention with long-lasting insecticide-treated nets. Indonesia was the first country in the region to introduce, in 2012, malaria screening at pregnant women’s first antenatal care visit to reduce the burden of malaria in pregnancy. The study assessed health providers’ acceptability and perceptions on the feasibility of implementing the single screening and treatment (SST) strategy in the context of the national programme in two endemic provinces of Indonesia.MethodsQualitative data were collected through in-depth interviews with 86 health providers working in provision of antenatal care (midwives, doctors, laboratory staff, pharmacists, and heads of drug stores), heads of health facilities and District Health Office staff in West Sumba and Mimika districts in East Nusa Tenggara and Papua provinces, respectively.ResultsHealth providers of all cadres were accepting of SST as a preventive strategy, showing a strong preference for microscopy over rapid diagnostic tests (RDTs) as the method of screening. Implementation of the policy was inconsistent in both sites, with least extensive implementation reported in West Sumba compared to Mimika. SST was predominantly implemented at health centre level using microscopy, whereas implementation at community health posts was said to occur in less than half the selected health facilities. Lack of availability of RDTs was cited as the major factor that prevented provision of SST at health posts, however as village midwives cannot prescribe medicines women who test positive are referred to health centres for anti-malarials. Few midwives had received formal training on SST or related topics.ConclusionsThe study findings indicate that SST was an acceptable strategy among health providers, however implementation was inconsistent with variation across different localities within the same district, across levels of facility, and across different cadres within the same health facility. Implementation should be re-invigorated through reorientation and training of health providers, stable supplies of more sensitive RDTs, and improved data capture and reporting.

To assess the effectiveness of various communication strategies for improving childhood pneumonia case management: study protocol of a community based behavioral open labeled trial in rural Lucknow, Uttar Pradesh, India

BackgroundCommunity Acquired Pneumonia (CAP) is the leading cause of childhood morbidity and mortality worldwide including India. Many of these deaths can be averted by creating awareness in community about early symptoms of CAP and by ensuring availability of round the clock, quality health care.The objective was to assess the effectiveness of an innovative package of orienting doctors and community health workers about community perceptions on CAP barriers to qualified health care seeking, plus infrastructural strengthening by (i) providing “Pneumonia Drug Kit” (PDK) (ii) establishing “Pneumonia Management Corner” (PMC) at additional primary health center (PHCs) and (iii) “Pneumonia Management Unit” (PMU) at Community health center (CHCs) along with one of 4 different behavior change communication interventions:Organizing Childhood Pneumonia Awareness Sessions (PAS) for caregivers of children < 5 years of age during a routine immunization day at PHCs and CHCs by Auxillary Nurse Midwives (ANM)Organizing PAS on Village Health and Nutrition Day only once a month in villages by Accredited Social Health Activist (ASHA)Combination of both Interventions 1 & 2Usual Careas measured by number of clinical pneumonia cases-treated by ANM/doctors with PDK or treated at either PMC or PMU.MethodsProspective community based open labeled behavioral trial (2 by 2 factorial design) conducted in 8 rural blocks of Lucknow district. Community survey will be done by multistage cluster sampling to collect information on changes in types of health care providers’ service utilization for ARI/CAP pre and post intervention.DiscussionCAP is one of the leading killers of childhood deaths worldwide. Studies have reported that recognition of pneumonia and its danger signs is poor among caregivers. The proposed study will assess effectiveness of various communication strategies for improving childhood pneumonia case management interventions at mother/community level, health worker and health center level. The project will generate demand and improve supply of quality of care of CAP and thus result in reduced mortality in Lucknow district. Since the work will be done in partnership with government, it can be scaled up.Trial registrationThis study has been registered retrospectively in the AEARCT Registry and the registration number is: AEARCTR-0003137.

A Cross-Sectional Study to Assess Capacity of Health Facility Laboratories in Zone One of Afar Regional State, Ethiopia.

Role of laboratory service in patient care is well recognized in developed compared to developing countries like Ethiopia where most medical decisions are based on clinical judgment. Laboratory based medical decisions save life and resources. Thus, health facilities (HFs) having capacitated laboratories provide better health care service. Thus, this study assessed capacity of laboratories found in all nine HFs in zone one of Afar region, Ethiopia. Cross-sectional study was conducted from January to May 2015. Data were collected using questioner from medical laboratory professionals (MLPs) and using cheek list from laboratory registration books. Collected data was analyzed using SPSS. Availability of laboratory related national guidelines and standard operating procedure varies among HFs studied. In 42 selected laboratory equipment and materials assessed, their availability shows variations among HFs from 13 (30.2%) to 32 (74.4%). Among different laboratory tests recommended to be performed at health center (HC) level by World Health Organization (WHO), six tests were not performed in all HC laboratories. Moreover, 11 (31.4%) MLPs received in-service training in the past one year. Internal quality control measures were done in 3 (33.3%) laboratories. However, all laboratories were involved in external quality assurance with varied schedules. Specimens after testing and specimen with prolonged transit time were discarded using standard rejection criteria in 8 (88.9%) and 3 (33.3) laboratories, respectively. Study showed that laboratories assessed have good capacities in involving external quality assurance and having proper laboratory test request format. But capacity of laboratories assessed is limited and unsatisfactory in number of laboratory tests performed at HC laboratories, in internal quality control measure implementation, and in getting up-to-date in-service training to staff. Thus, to enhance capacity of laboratories in HC, responsible bodies shall avail basic laboratory materials and equipment, make fair distribution of MLPs, provide up-to-date training, and implement internal quality control measures in laboratories.

Healthcare professionals' knowledge, attitude and practice towards adverse drug reaction (ADR) reporting at the health center level in Ethiopia.

Background Adverse drug reactions (ADRs) are major health problems which are of global concern. Spontaneous reporting of adverse drug reactions constitutes a crucial contribution to patient care. Objective The purpose of this study was to assess the knowledge, attitudes, and practices of healthcare professionals towards adverse drug reaction reporting. Setting Health care professionals in Gondar, Ethiopia. Methods A cross-sectional study was conducted from March to May 2017. Data were collected through self-administered questionnaires. The collected data were analyzed using SPSS version 20. Binary logistic regression analysis was performed to distinguish factors that affect adverse drug reaction reporting. A p value < 0.05 was considered as a statistically significant. Main outcome measure Factors affecting adverse drug reaction reporting of health care professionals. Results Of 102 healthcare professionals included in this study, 61 (59. 8%) were nurses, 16 (15.7%) health officers, and 25 (24.5%) pharmacy professionals. Nearly 48 (47%) study participants had an inadequate level of knowledge towards adverse drug reaction reporting. The majority of participants 88 (86.3%) had a positive attitude, while more than half (51%) of study participants did not report the adverse drug reaction they encountered. Participants who had not taken adverse drug reaction reporting training (p = 0.037), health officers (p = 0.019), and nurse professionals (p = 0.001) showeda statistically significant association with an inadequate level of knowledge. Conclusion Even though the majority of healthcare professionals had a positive attitude, they had an inadequate level of knowledge and practice towards adverse drug reaction reporting.

Menentukan Rujukan Rumah Sakit Terbaik Bagi Pasien BPJS Menggunakan Metode Weighted Sum Model (WSM) Pada Puskesmas

BPJS Health is one of the most important services for the community. For people who are sick and have been registered in BPJS, then the cost of treatment will be borne by the BPJS and the community is what is said as Patient BPJS. However, if a patient BPJS experiencing pain, then the patient first went to the health center or Faskes level 1 before being referred to the Hospital. Therefore, this study aims to build decision support system that has the ability to analyze in determining referral hospital for Patient BPJS at puskesmas or Faskes level 1. The method used in this research is Weighted Sum Model (WSM). The hospital samples used as many as 10 obtained from UPT Puskesmas Padang Bulan, Jln. Jamin Ginting - Medan. Based on calculations performed obtained the highest value of 77.5, ie on RS3. Therefore, this hospital is the foremost hospital as a reference for Patients BPJS. This research is expected to help the Puskesmas or Faskes level I in the city of Medan in providing hospital referrals for patients BPJS.

Monitoring and evaluation of intranatal facilities at community health centre level in Siddharth Nagar district

Background: Despite WHO and UNICEF are leaving no stone unturn to promote breastfeeding in health facilities globally, there is poor status of breastfeeding in rural India till today. in 2012, U.P had one of the poorest maternal and neonatal health outcomes in India. Assessment the implementation of practice of skin to skin contact and early initiation of breastfeeding.Methods: It was a descriptive longitudinal study. This study was carried out in CHC Khisraha and CHC Mithwal in Siddharthnagar, over a period of 3 months. All pregnant women admitted for normal delivery during data collection period and had positive outcome was our study sample. A total of 101 samples were observed and interviewed.Results: Most of the beneficiaries were from age group 20-22 years (46.5%). Pre-term delivery was high (26.7%) in present study. Only in 12% of cases radiant warmer were switched on 20-30 minutes before delivery. Only 3% of babies born were dried with pre-warmed towel/cloth. Practice of skin to skin contact was observed in 97% of cases. Only in 18.8% of cases babies followed breast crawl. All babies were given pre-lacteal feed. Only in 8.9% of cases initiation of breastfeeding was done within 30 minutes.Conclusions: Supportive supervision of staff nurses for STS contact and BF initiation is needed. Counselling and training of ASHA worker about benefits of early BF and STS contact for both mother and baby.

Quality of care for children with acute malnutrition at health center level in Uganda: a cross sectional study in West Nile region during the refugee crisis

BackgroundArua district, in Uganda, hosts some of the largest refugee camps in the country. The estimated prevalence of moderate and severe acute malnutrition in children is higher than the national estimates (10.4 and 5.6% respectively, compared to 3.6 and 1.3%). This study aimed at assessing the quality of care provided to children with acute malnutrition at out-patient level in such a setting.MethodsSix facilities with the highest number of children with malnutrition were selected. The main tool used was the National Nutrition Service Delivery Assessment Tool, assessing 10 key areas of service delivery and assigned a score as either poor, fair, good or excellent. Health outcomes, quality of case management and data quality were assessed from the health management information system and from the official nutrition registers.ResultsAll facilities except two scored either poor or fair under all the 10 assessment areas. Overall, 33/60 (55%) areas scored as poor, 25/60 (41%) as fair, 2/60 (3.3%) as good, and none as excellent. Main gaps identified included: lack of trained staff; disorganised patient flow; poor case management; stock out of essential supplies including ready-to-use therapeutic foods; weak community linkage. A sample coverage of 45.4% (1020/2248) of total children admitted in the district during the 2016 financial year were included. The overall mean cure rate was 52.9% while the default rate was 38.3%. There was great heterogeneity across health facilities in health outcomes, quality of case management, and data quality.ConclusionThis study suggests that quality of care provided to children with malnutrition at health center level is substandard with unacceptable low cure rates. It is essential to identify effective approaches to enhance adherence to national guidelines, provision of essential nutritional commodities, regular monitoring of services and better linkage with the community through village health teams.

Sustainability of Benefits from Parenting Interventions Delivered Through Health Services: Follow-Up at Age 6 Years of a Cluster Randomized Trial

Background: There is strong global demand for parenting interventions feasible and cost effective at scale. Effect sizes are usually lower at scale and there is little information on sustainability of gains following smaller initial impact. Methods: A cluster randomized trial of two parenting interventions was conducted through 20 health centres in Jamaica. The centres were randomly assigned to 4 groups, control (n=150 mother-child pairs), health centre intervention (n=146), home-visit intervention (n=50) or both (n=50) using a computer-generated randomization sequence. Interventions were implemented from age 3-18 months and each intervention benefited cognitive development at 18 months (effect size 0.34-0.38SD). Children were reassessed at 6 years (n=262, 66.2% of those enrolled) to determine any benefits to IQ, school readiness and behaviour, and parenting behaviour. Loss to follow-up was not significantly different by treatment. Inverse probability weighting and Lee bounds were used to adjust for loss to follow-up, and multilevel regression analyses conducted with random effects at the health centre level. Findings: There were no significant benefits to any child outcomes at age 6 years or to parenting behaviour. Lee bounds estimates confirmed that effects remained indistinguishable from zero and in no case were both bounds statistically different from zero. Interpretation: Lack of sustained benefits may be related to small initial effect size and low intensity of the intervention that ended very young at age 18 months. The sample was also less disadvantaged than in prior Jamaican studies. The findings have implications for intervention design, in particular, duration, intensity and targeting. Clinical Trial Number: The original trial is registered with the ISRCTN Register, identifier number ISRCTN43108304 Funding Statement: This project was funded by the Inter-American Development Bank. Declaration of Interests: Dr Lopez-Boo is employed by the Inter-American Development Bank; the other authors have no no competing interests to declare. Ethics Approval Statement: Ethical approval for the study was obtained from the University of the West Indies Ethics Committee.

HE1 - Effect of a Provider-Focused Asthma Care Quality Improvement Program on Patient-Level Asthma-Related Health Care Costs

Enhancing Care for Patients with Asthma (ECPA) is a real-world quality improvement program that has been executed in health centers that serve patients with asthma in Illinois, New Mexico, Texas, and Oklahoma. The ECPA focused on furnishing asthma guidelines-based processes as a structural quality improvement approach. While the ECPA has been implemented in these states since 2013, the translational and sustainable effect on reducing patient-level health care costs is unknown. The study objective was to examine the effect of this multi-state, multi-center quality improvement program on individual-level asthma-related health care costs. This study employed a pretest-posttest quasi-experimental design and utilized administrative claims data from a private insurer providing coverage to patients receiving asthma care from participating health centers. Patients were attributed to a health center if they had at least one asthma claim in a participating center during the 12-month pre-implementation and 12-month active implementation periods. Asthma-related total annual health care costs per patient were determined during pre-implementation, implementation, and post-program completion. Three-level generalized linear mixed models (GLMMs) with lognormal distribution estimated the ECPA effect on annual health care costs and accounted for correlation of repeated outcome measures of each patient and nested health centers. All costs were inflated to constant U.S. dollars. 1,696 patients with asthma were attributed to participating health centers. Asthma-related total annual health care costs decreased from $11,914,326 during 12-month pre-implementation period to $5,544,536 during 12-month implementation period (53.5% cost reduction). GLMMs results found ECPA implementation was associated with a 56.5% reduction in total health care costs (95% CI -60.71%, -51.87%; p-value<.0001); post-program completion was associated with a 57.4% reduction (95% CI -61.83%, -52.44%; p-value<.0001). Asthma quality improvement efforts at the health center level are associated with sustainable reductions in asthma-related ER and total health care costs measured at the patient level.

The management of livedoid vasculopathy focused on direct oral anticoagulants (DOACs): four case reports successfully treated with rivaroxaban.

Livedoid vasculopathy (LV) is a thrombotic skin disease characterized by episodic painful ulcerations of the distal aspects of the legs. Its healing process typically leaves small porcelain-white scars called atrophie blanche as a result of the occlusion of cutaneous microcirculation. The main goals of the treatment are pain management and the prevention of ulceration and of progressive scarring in the malleolar area. The therapeutic management is still a challenge, however, and most treatments were based on anecdotal off-label protocols. Over such context, direct oral anticoagulants (DOACS) arise as a potential treatment for this disease. This class of medications became an alternative from initial large studies applied on different pathologic scenarios regarding thromboembolic events. In that line, recent case series using DOACS, including rivaroxaban, started to emerge in the literature related to LV and reported successful prevention of cutaneous infarctions and ulcerations, providing physicians with a new promising alternative. The current report describes four cases of long-term recalcitrant LV, in which rivaroxaban monotherapy effectively reduced pain and cutaneous ulcerations in a few weeks of treatment without relevant side effects. The authors also review therapy management of the disease, focused on DOACS, and suggest a step-by-step approach to treat these patients, taking into consideration different resource profiles of each level of local health centers, the gravity of the cases, and risks/benefits for patients.

There and Back Again: How the Repeal of ACA Can Impact Community Health Centers and the Populations They Serve.

We examined the impact of Medicaid expansion on rates of the remaining uninsured at the federally qualified health center level by race/ethnicity, limited English proficiency, and poverty status of their patients. Results indicated a systematic disadvantage in nonexpansion states for federally qualified health centers with high concentrations of these populations and an advantage in expansion states for federally qualified health centers with fewer limited English proficiency patients. Our findings highlight the importance of maintaining the Affordable Care Act in reducing disparities in coverage and the importance of federal funding to continue services for the remaining uninsured and vulnerable populations in both expansion and nonexpansion states.

Barriers Associated with Misuse of Laboratory in Antenatal Care in Senegal: A Quantitative Approach

Barriers Associated with Misuse of Laboratory in Antenatal Care in Senegal: A Quantitative Approach Maternal mortality remains high in developing countries; however laboratory can help to fight against this problematic situation. In Senegal, six (6) tests are recommended by the national program, for antenatal screening. This study aimed to identify barriers regarding utilization of laboratory, by pregnant women, during antenatal care (ANC), in Senegal. A cross-sectional study was conducted in 16 peripheral health facilities, 12 health centers and 4 hospitals (EPS1). Data were collected, amongst 1692 pregnant women, 61 midwives, 99 laboratory staffs and 16 administrators, from February 2013 to July 2014. Pregnancy age, gestity, parity, pregnant age, ANC location were variables studied from pregnant women. From the laboratory, timely accessibility, concordance of opening hours with ANC services, availability of reagents and equipments, skilled laboratory staff, acceptability of results delivery, tests prices visibility, confidentiality and adequacy of infrastructures, were investigated. From ANC, waiting time, availability of skilled midwives and guidelines, adequacy of waiting rooms and infrastructures, were studied. Data were entered in Microsoft Excel version 2013 and Open Clinica 3.1.3, then exploited and analyzed in SPSS version 20. Laboratory misuse was 87.88% among 1692 pregnant women who went to the facilities for the first ANC visit. The whole population had 25.25 ±6.19years [20-29 years] (55%), first pregnancy trimester (54%), multigest (66%), multiparous (42%), had frequented health centers (75%). In the multivariate model, variables independently associated with laboratory use were: gestity, parity (more than 3), confidentiality, affordability of tests prices, availability of guidelines and health center level. Most of the barriers are supply-health systems. It is then important to take into account these results, to sensitize pregnant women, health personnel and authorities for a better use of the laboratory during antenatal care.

Information technology in morbidity management of human lymphatic filariasis-A promising tool in global programme for elimination of lymphatic filariasis.

India is a signatory to the 1997 World Health Assembly resolutions on lymphatic fila- riasis, and other neglected tropical diseases, and supports global elimination of lymphatic filariasis by 2020. The global programme to eliminate lymphatic filariasis (GPELF) has two main components, viz. interrupting transmission of LF through mass drug administration; and managing morbidity and preventing disability. Consorted efforts by the Public Health Department in Tamil Nadu state (India) for elimination of LF was launched in the year 1997 concentrating on both the components of the programme. The data on the prevalence of filarial morbidity and its entire management at present is based on manual reports and registers maintained by the field functionaries. To overcome the constraints in the manual reporting, an attempt was made to develop a web-based reporting system with different modules and user-friendly interface. The Vellore and Thiruvannamalai districts were selected as a study area. The study was conducted between 2011 and 2014, which revealed that the entire morbidity management was based on the manual formats. Constraints in the present manual reporting were analysed. PHP and MySQL tools were used to generate user friendly modules. Feedback was collected from field functionaries at different health centre levels, on the adequacy in the modules and effectiveness of the web-based reporting system. The online reporting modules facilitated data entry at the health subcentre level itself. Analysis and retrieval of data was facilitated at all other levels in the public health system. The modules also covered details of surgical interventions, ex-gratia payments and other benefits extended to the lymphoedema patients by the Government. The usage and feedback of the web-based reporting system appeared very encouraging and reliable, indicating that it can be implemented in health programmes for disease management. This web-based user-friendly online reporting system can contribute largely to achieve the goals of the GPELF; specially after MDA is withdrawn.

Perception of health-care staff's knowledge, attitudes, and practices and of potential barriers toward containing antibiotic resistance in public health-care facilities of Tumkur district (South India)

Background: India faces a major public health problem of antibiotic resistance. The rational prescription practices with behavioral change of health-care staff are one of the potential interventions for containment of antibiotic resistance at the health centers level. Yet, not much is known about the perceptions of health workers. Methodology: The present study evaluated the knowledge, attitude, practices, and barriers around antibiotic usage and resistance among the government health staff by a quantitative survey of 118 health-care providers (60 physicians and 58 pharmacists) across Tumkur district of Karnataka – 53 government health facilities from all levels – 1 district hospital (DH), 4 taluk hospitals, and 48 primary health centers. Results: Antibiotic resistance was perceived as an important problem globally, nationally, and locally by 81.3% (n = 96) and 83.8% (n = 99) and 54.2% (n = 64), respectively. About 86% (n = 52) of doctors were not aware of top three resistant organisms prevalent in their center. Only 38% (n = 23) sought microbiologist's input for antibiotic recommendations. Unavailability of antibiotics was quoted a major barrier to practice (78%, n = 47), followed by unregulated over-the-counter sale (OTC) (62%, n = 37) and high work-load (56.6%, n = 34). About 87% (n = 52) of the physicians and 98% (n = 57) of pharmacists expressed their interest for a potential educational program in antibiotics and resistance. Microbiology record (July–December 2013) from DH revealed only 22 isolates from 54 processed samples and resistance data were not recorded. Conclusions: While issues around antibiotics unavailability and OTC sales are being addressed at the center, the perceptions of the public health center's staff seem to have been overlooked. The laboratory support is grossly underutilized by the staff-culture seeking behavior of the practicing physicians needs to be enhanced, and laboratory strengthening at DH is imperative. The District seems ready for the implementation of Antibiotic stewardship programs, which may be introduced by the state as an educational intervention to address the gaps in knowledge, attitude, and practices of the staff.

Prevalence and Epidemiology of the Arterial Hypertension of the Adult in Kamina in the Democratic Republic of the Congo

High blood pressure (HTA) is a cardiovascular disease more prevalent in consultations in internal medicine; it is until now less controlled in the world, especially in developing countries where the majority of hypertensives are not controlled. In general, it is estimated that hypertension affects between 10% to 15% of the adult population. In some countries the prevalence is slightly higher (about 20% of the adult population) and in some Eastern European countries an even higher prevalence has been observed (up to 30%). This is a cross-sectional descriptive study on the prevalence and epidemiology of HTA in Kamina. The study was spread over a 12-month period from January 2017 to December 2017. This study found that out of 222 patients received in internal medicine at the Kamina General Referral Hospital in 2014, 187 subjects represented 84 patients. 2% had different pathologies compared to 35 subjects, i.e. 15.8% had hypertension. We found that participants aged 60 and over are more represented with a workforce of 18% or 51.4% while subjects aged 40-59 represent only a workforce of 5% or 14.3%. As for sex, women are more affected by HTA with a workforce of 21% or 60% while men represent a workforce of 14% or 40%. To better contribute to the reduction of the morbidity and mortality associated with the complications of hypertension, it is necessary to act early upstream according to the extent of this pathology, even at the level of the basic health centers. The significant proportion of severely hypertensive patients requires greater awareness to consult for their follow-up and management.

A study on morbidity pattern among geriatric population of an urban slum, Dehradun, India

Background: Ageing is a process of deterioration in the individual’s functional capacity that results from structural changes as age advances. India has acquired the label of “an ageing nation” with 7.7% of its population being more than 60 years old. Research on geriatric morbidity and related risk factors are required to improve the delivery of health care to the elderly. This study was an attempt to study the morbidity status of geriatric people that may serve as a baseline data and also help in planning the health services. Aims and Objectives: To ascertain determinants and predictors as potential socio-epidemiological correlates of the prevalent morbidity pattern and recommend appropriate measures / interventions to address felt and unmet needs in geriatric health. Material and Methods: An observational study conducted in field practice area of Department of Community Medicine, Himalayan Institute of Medical Sciences, HIHT, Dehradun. Study participants aged above 60 years were administered by pre tested, semi structured questionnaire after obtained informed consent. Descriptive statistics were calculated by using SPSS version 17. Results: Among 520 subjects most common morbidity in study subjects was arthritis (49.61%) followed by cataract (46.34%), chronic gastritis (44.23%), COPD (25%), diabetes (21.15%), skin lesions (19.03%), hypertension (11.39%). Conclusion: There is high morbidity rate identified in this present study so there is an urgent need to develop geriatric health care services at primary health centre level

Efficacy of Tamarindus indicus, Melia azadirach and Santalum album in syndromic management of abnormal vaginal discharge: A single-blind randomised controlled trial

Background At least 25 % of women attending genitourinary medicine (GUM) clinics receive treatment for one of the three common causes of abnormal vaginal discharge: bacterial vaginosis, candidiasis and trichomoniasis. Syndromic diagnostic approach was adopted by National AIDS Control Organisation (NACO) India, at the primary health centre level. Syndromic management implies the simultaneous treatment of two or more infections. The aim of this study was to assess efficacy of sandal sufaid, maghze tukhme bakayin and khaste tamar hindi in syndromic management of Sailanur rehm. Methods This study was a randomized, single blind, standard controlled trial. It was conducted to compare efficacy of formulation which contains buradae sandal safaid, safoofe maghze tukhme bakayin, safoofe khaste tamar hindi and safoofe shakkar safaid against combination of azithromycin, fluconazole and secnidazole on diagnosed subjects of Sailanur rehm. Test group received 10 g of test drug B.D for 21 days while control group received single dose of standard drug to both the partners. Vaginal symptom score (VSS) was used for assessing discharge and associated complaints. Visual analogous scale (VAS) was used for assessing low backache and lower abdominal pain. Results There were no significant differences between the two groups concerning baseline characteristics (p>0.05). VSS was significantly decreased with p<0.001 for both control and test group. VAS was significantly decreased with p<0.001 and p=0.07 in test and control group respectively for low backache. For lower abdominal pain p=0.006 for both groups after the completion of treatment. Conclusions The formulation can effectively alleviate the disease with associated symptoms without any side effects. It can be used in syndromic management of vaginal discharge. Future research is on large sample size.