Heath Center Research Articles

“Entre Nosotras:” a qualitative study of a peer-led PrEP project for transgender latinas

BackgroundUptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities.MethodsThis paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis.ResultsBeneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support “entre nosotras” (“between us women/girls”). The combination of these factors contributed to the intervention’s success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and “en casa/ at home” in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation.ConclusionsOur research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.

“I’ve discovered the COVID-19 vaccine”. Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic

IntroductionA 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.ObjectivesThe objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.Methods3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.ResultsSeveral randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.ConclusionsThe insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.DisclosureNo significant relationships.

The Expression Changes of CX3CL1 and Interlukin-6 Genes During Remission Induction Therapy in Patients With Acute Myeloid Leukemia

Background: Acute Myeloid Leukemia syndrome (AML) is a hematologic malignancy which is due to clonal extensive proliferation of leukemic precursor cells and is rapidly fatal unless treated or response to chemotherapy. Cytogenetic findings have important role in prognosis and categorization of AML. The aim of this study was to investigate the expression changes in CX3CL1 and Interlukin-6 (IL-6) genes before and after chemotherapy as remission induction therapy in AML patients. Materials and Methods: In this study 69 patients (36 males, 33 female) with AML was selected from tertiary medical heath center. A quantitative polymerase chain reaction (PCR) was done for mRNA expression of CX3CL1 and IL-6genes before and after induction chemotherapy. To obtain expression changes in CX3CL1 and IL-6genes, we used 2-ΔΔCT method. Results: The expression of CX3CL1 and IL-6 was significantly increased after induction chemotherapy. Also, the ΔCt mean of CX3CL1 and IL-6 mRNA was not significant between AML subtype groups. Conclusion: In conclusion, as we showed that chemotherapy significantly increase the expression of CX3CL1 and IL-6 which can be used as a prognostic factor of AML.

Knowledges, Attitudes and Practices of Diabetic Patients Face to Diabetic Retinopathy in Parakou in 2019

Introduction: Diabetic retinopathy is one of the main causes of blindness. Preventive measures and screening will reduce its impact. Objective: Study the knowledges, attitudes and practices of diabetic patients about diabetic retinopathy from 03 hospitals in the District of Parakou in 2019. Methods: The study was carried out in 03 hospitals in northern Benin (University and Regional Health Center of Borgou and Alibori, Army Health Center of Parakou, and the Diabetes Center of Benin. This was a descriptive and analytical cross-sectional prospective study that covered a period of 03 months from 15th May to 20th August, 2019. The sampling method was non-probability. Selection of diabetic patients was exhaustive taking care for the consent of each patient. The aged group was at least 18 years old and above, resident in Parakou and followed up in one of the above heath centers. We enrolled 150 patients after submitted them to some questionnaires. Results: From the total number of 150 patients, 59.33% were male. The mean age was 55.07 ± 11.62 years. The participants were predominantly married (87.33%) and 62% of them were literate. 48% of patients said diabetes mellitus is responsible of eye complications. 52% and 12% of patients reported that balancing blood sugar and normalizing blood pressure, respectively, are preventative factors for diabetic retinopathy. 27.33% of patients reported the need for a regular eye fundus exam. 12.67% of patients have a regular annual eye fundus examination and 56.67% of patients have never had one. Education and gender were associated with level of knowledges; education and low income were associated with level of practices. Conclusion: Reducing the impact of diabetic retinopathy requires better involvement of the diabetic patient, the ophthalmologist, the endocrinologist and the authorities of the Ministry of Health.

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study.

High HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. A qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis. Four categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations. Understanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.

IMPLEMENTATION OF TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING AT TANAH KALIKEDINDING HEALTH CENTER SURABAYA CITY, 2020

Abstract Background One of the government's efforts to increase the achievement of exclusive breastfeeding is the 10 LMKM program. Since 1991 in Indonesia, it has been introduced, but in its implementation it is not yet known by all health facilities even though several existing steps have been implemented, but the 10 LMKM policy has not been known by providers.Objectives Describe implementation and barriers to providers in program implementation, identify compliance and barriers to mothers as program recipients. Methods The research used descriptive qualitative research. The sampling technique used was purposive sampling to explore the implementation of 10 LMKM in Tanah Kalikedinding Health Center. Informants in accordance with the inclusion criteria 7 providers and 8 mothers as program recipients. Researchers interacted offline and online via video calls while adhering to health protocols. Results The implementation of 10 LMKM has been running with the internal policies of the Puskesmas referring to the Permenkes, carrying out tasks according to the SOP. Several providers have attended training and disseminated it to staff. Monitoring and evaluation is carried out through the credential team at the Puskesmas. Officers in implementing 10 LMKM to support the achievement of exclusive breastfeeding are committed to complying with the SOP. Provider barriers from external factors are the lack of health workers, especially midwives on duty, so that KIE regarding breastfeeding and others is not optimal. Mothers as program recipients when ANC is already in IEC, obediently follow the services provided and have not been fostered or referred to breastfeeding support groups. Barriers to exclusive breastfeeding in program implementation are influenced by external factors of working mothers. Conclusion The implementation of the 10 LMKM program at the Tanah Kalikedinding heath center has not been maximized.

IMPLEMENTATION OF TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING AT TANAH KALIKEDINDING HEALTH CENTER SURABAYA CITY, 2020

Abstract Background One of the government's efforts to increase the achievement of exclusive breastfeeding is the 10 LMKM program. Since 1991 in Indonesia, it has been introduced, but in its implementation it is not yet known by all health facilities even though several existing steps have been implemented, but the 10 LMKM policy has not been known by providers.Objectives Describe implementation and barriers to providers in program implementation, identify compliance and barriers to mothers as program recipients. Methods The research used descriptive qualitative research. The sampling technique used was purposive sampling to explore the implementation of 10 LMKM in Tanah Kalikedinding Health Center. Informants in accordance with the inclusion criteria 7 providers and 8 mothers as program recipients. Researchers interacted offline and online via video calls while adhering to health protocols. Results The implementation of 10 LMKM has been running with the internal policies of the Puskesmas referring to the Permenkes, carrying out tasks according to the SOP. Several providers have attended training and disseminated it to staff. Monitoring and evaluation is carried out through the credential team at the Puskesmas. Officers in implementing 10 LMKM to support the achievement of exclusive breastfeeding are committed to complying with the SOP. Provider barriers from external factors are the lack of health workers, especially midwives on duty, so that KIE regarding breastfeeding and others is not optimal. Mothers as program recipients when ANC is already in IEC, obediently follow the services provided and have not been fostered or referred to breastfeeding support groups. Barriers to exclusive breastfeeding in program implementation are influenced by external factors of working mothers. Conclusion The implementation of the 10 LMKM program at the Tanah Kalikedinding heath center has not been maximized.

Relationship of Parities with Benefits Knowledge of Maternal and Child (KIA) Book for Pregnant Women at Public Heath Centre 1 Gamping 1

Public awareness about pregnant women health’s still a determining factor for MMR and IMR. Although there are still many factors that must be considered to deal with this problem, one of the causes of death is the ignorance of pregnant women and their families in recognizing danger signs of pregnancy, to solve this the government is trying to improve awareness and knowledge of pregnant women and their families with maternal and child health books (KIA). This study aims to to determine whether there is a relationship between parity and knowledge about the benefits of the KIA Handbook for pregnant women at Gamping 1 health center. This research is a quantitative study. The data collection method based on the time approach used is the cross section method. The sampling technique used was purposive sampling, namely taking samples according to the inclusion and exclusion criteria of 45 respondents with the Chi Square relationship test with a significance level of 95%. Chi Squere test results show that the p-value is 0.020. Therefore, the p-value α (0.05) means that there is a relationship between parity and the knowledge of pregnant women on the KIA Handbook at the Gamping 1 Health Center in Yogyakarta. Pregnant women are expected to continue to use and read the KIA Handbook during pregnancy in order to increase mother's knowledge.

Do the Readings of Digital and Aneroid Sphygmomanometer Concur? A Clinic-Based Study in an Urban Area of South Kolkata

Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen’s Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value <0.05 was considered significant for the statistical test in the analysis. Results: Cohen’s Kappa value (0.59) revealed these two tools had moderate agreement in diagnosing hypertension. Sensitivity and specificity of digital sphygmomanometer taking aneroid sphygmomanometer as gold standard is 86% and 83.1% respectively. The BP readings of these two-tools showed moderate correlation as Intraclass Correlation Coefficient (ICC) for Systolic BP (SBP) and Diastolic BP (DBP) were 0.804 and 0.624, respectively. Bland Altman plot showed gross disagreement of SBP findings and disagreement between DBP findings was also noted. Conclusion: Digital device was found to be less accurate in detecting hypertension. Therefore, more similar research work is solicited to verify the accuracy of the very easy to use, the Digital BP monitor.

Vaccines Summit 2021: The body acts against facts of physics in fever - K. M. Yacob - Marma Heath Centre

Vaccines Summit 2021: The body acts against facts of physics in fever - K. M. Yacob - Marma Heath Centre

Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities.

Background:The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people.Methods:We applied multinomial logistic regression models based on Andersen’s Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services.Data:We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam.Results:Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that “having to pay cost” and “having sufficient income” were strong predictors for using commune health centres, district hospitals, and private facilities, while “having health insurance” was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities.Conclusions:Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.

Knowledge deficit on health promotion activities during pregnancy: the case for adolescent pregnant women at Chiladzulu District, Malawi

BackgroundAdolescent pregnancy is a public health concern in Malawi as it is associated with high risks of adverse pregnancy outcomes. Almost 29% of adolescent women aged 15–19 years are already mothers and adolescent fertility rate is also high estimated at 136 per 1000 women. Therefore, the aim of the study was to explore knowledge of pregnant adolescents on importance of antenatal care and health promotion during pregnancy.MethodsA qualitative descriptive design was used to solicit information on significance of antenatal care and how adolescents promote their health during pregnancy. Data was collected from 77 pregnant adolescents, purposively sampled from Namitambo and Namadzi Heath Centres in Chiladzulu District, Malawi. A semi-structured interview guide was used for data collection. Data were analysed manually following principles of qualitative content analysis.ResultsThemes that emerged from the qualitative data included: knowledge deficit on the purpose and benefits of antenatal care; knowledge deficit on services offered at antenatal care clinic; knowledge deficit on danger signs during antenatal period and antenatal emergency care; knowledge deficit on effects of alcohol and smoking; knowledge deficit on nutrition during pregnancy; and knowledge deficit on importance of rest during pregnancy.ConclusionThis study has shown knowledge deficit among adolescent mothers that may contribute to poor pregnancy outcomes. Several factors could be attributed to such knowledge deficit. Therefore, healthcare systems and healthcare professionals have a responsibility to enhance health literacy of pregnant adolescents with an ultimate goal of improving maternal and neonatal health outcomes.

Positioning operations in the dental safety net to enhance value-based care delivery in an integrated health-care setting.

Impact of implementing data-driven performance metric-tracking across a 10-dental center infrastructure established by Family Heath Center of Marshfield (FHC-M) was examined for relative impact on achieving value-based care delivery in serving a patient population characterized by 88% Medicaid representation. To track progress toward national benchmarks for preventive care delivery, dental quality analytics dashboard tracking was implemented in real time with sharing of performance metrics across centers. Compliance rate with Uniform Data Systems reporting requirements for sealant placement on permanent first molars in children aged 6-9 years of age at moderate-to-high risk of caries was targeted at FHC-M dental centers for comparison with those of other community health centers statewide and nationally. Hygienist-to-dentist ratio to support robust sealant placement capacity was further examined. Uniform Data Systems data for rate of sealant placement between 2016-2018 revealed that FHC-M consistently exceeded rates reported statewide and nationally. For this quality indicator, performance across all dental practices in 27 states reported by Centers for Medicare and Medicaid Services in 2018 achieved 23% in 2017 compared to 73% and 52% placement rates reported by FHC-M and community health centers, respectively. A 1:1 hygienist-to-dentist was documented across FHC-M dental centers compared to 0.5:1 reported nationally. Implementation of quality metric dashboard and a 1:1 dentist-to-hygienist ratio supported realization of value-based dental care delivery relative to caries prevention in a moderate-to-high risk pediatric Medicaid population through achievement of robust sealant placement. Importance of adequate hygienist staffing, "same day" sealant placement and performance feedback supported by technology are highlighted.

Blood donation practice and associated factors among health professionals working at heath centers in Nefas Silk Lafto sub city, Addis Ababa, Ethiopia

<p class="abstract"><strong>Background:</strong> Accessibility of a safe and adequate blood transfusion is a challenge worldwide and even more critical in Africa. Even though blood donation is lifesaving practice, current blood supply is far less compared to the demand in Ethiopia. However, there is limited information in Ethiopia. Therefore, this study aimed to assess blood donation practice and associated factors among health professionals working at heath center in Nefas Silk Lafto sub city, Addis Ababa, Ethiopia.</p><p class="abstract"><strong>Methods:</strong> Institution based cross-sectional study was conducted among health professionals working at health centers in Nefas Silk Lafto sub city, Addis Ababa from 23 August 2019 to 20 September 2019. Simple random sampling technique was used to select the study participants. Data were collected used self-administered structured questionnaire. Binary logistic regression analysis was used for data analysis. </p><p class="abstract"><strong>Results:</strong> 459 health professionals were included in the study with a response rate of 98.4%. Only 157 (34.2%) of them donated blood in the last five years. Age (AOR=1.72, 95% CI: 1.06, 2.79), blood collection site (AOR=3.46, 95% CI: 2.03, 5.89), blood collection working (AOR=2.00, 95% CI: 1.16, 3.44) and knowledge (AOR=0.32, 95% CL: 0.14, 0.76) were significantly associated with blood donation practice.</p><p class="abstract"><strong>Conclusions:</strong> Blood donation practice was low. Age of health professionals, blood collection site, blood collection working hour and knowledge were significantly associated with blood donation practice. Therefore, establish fixed and mobile collection site and convenient time for blood donors and awareness creation is crucial.</p>

Low analysis of community interest maintenance in Central Health Center Sukmajaya Kota Depok Provinsi Jawa Barat

According to the recapitulation of the utilization of Community Health Center inpatient services in Depok in 2016-2018, it was very low. The results of an initial survey in October 2018 conducted by Community Heath Center researchers who only served inpatients in only 3 districts, while 1 sub-district had not served general inpatients since one year ago. Of the three sub-districts, only 1 sub-district has inpatients, while others sometimes do not have an in-patient visit within one month. Sukmajaya Community Health Center was appointed to serve general inpatient care, basic neonatal obstetric services and care for malnourished children. Because of the low number of inpatient visits in the city of Depok, the researchers were interested in knowing the strengths and weaknesses as well as the opportunities and threats of the Sukmajaya Community Health Center. This study used a qualitative method conducted in February 2020 with in-depth interviews using interview guidelines and voice recording devices. Interviews were conducted with the Head of the Community Health Center, Head of Administration, Responsible for Inpatients, Doctors and Nurses. As a result, Sukmajaya Community Health Center was unable to compete with Private Hospitals because private hospitals had better health personnel and infrastructure than Sukmajaya Community Health Center. Besides that, the number of private hospitals in the city of Depok is large and the location is easy to reach, so people prefer hospitals with more convenient facilities.

Intention Versus Uptake: LARC Among Postpartum Women in a Federally Qualified Health Clinic [17J

INTRODUCTION: Access to full spectrum contraceptive methods, including long-acting reversible contraception (LARC), is critical for preventing unintended and short-interval pregnancy. Despite serving a population at high risk for unintended pregnancy, federal qualified heath centers (FQHC) often have limited access to LARC on-site and at associated hospitals that may impact contraceptive utilization. The goal of the study was to examine access and barriers to LARC uptake among women at a FQHC. METHODS: We conducted a retrospective chart review of all women seen for antenatal care at a single resident run FQHC from 2014 to 2017. Women age 18-40 and who delivered at the associated hospital were included. The FQHC offered intrauterine device (IUD) but did not offer contraceptive implant placement. The associated hospital did not provide immediate postpartum LARC during the study period. RESULTS: In our study, 560 women were identified. There was a 60.5% postpartum follow-up over the study period. 65% (n=364) had documentation of a confirmed postpartum contraception plan prior to delivery. Of women with a plan, 27% (n=100) expressed desire for postpartum LARC. Only 21% (n=21) of women who desired LARC actually received LARC within the first 6 months after delivery. All IUDs were received at the FQHC. No women received a contraceptive implant at an outside facility. CONCLUSION: Our data suggests that when LARC options are not readily available, postpartum uptake is poor regardless of intention. Therefore, strategies need to be developed to improve access to all LARC methods, including expanding immediate postpartum services and improving antepartum contraception counseling.

The Effects of the Performance Based Financing (PBF) on Health Institutions Performance in Rwanda

Health Institutions in Rwanda are facing with various difficulties related to the responses they must reserve the needs of the population’s health. Infrastructures and equipment does not meet the needs of population, insufficiency of health staff and staffs no motivated and low motivation, the decrease of performance, etc. Hence the introduction of Contractual Approach (AC) or Performance Based Financing (PBF) policy was taken as a solution of the problem. The PBF was designed to improve health services performance. It seems that the performance goal is not yet effectively achieved because the complaints are still raising, rewashing and are felt in different health centers (HC) in Rwanda. Thus, the present study of the effects of the Performance Based Financing (PBF) on health institutions performance in Rwanda, case Rwamagana District Health Centers, period 2007-2010, seems valuable. The objectives of the study were to determine the level of staffs satisfaction and motivation by PBF; to identify the factors of motivation and measure the increasing performance increasing. The research adopted the descriptive design and the sample were 6 in 11 heath centers and a total 86 respondents in 172 staffs were selected randomly. The data were collected through questionnaires and analyzed with SPSS v21, descriptive statistics, correlation analysis and ANOVA Model were used. The study findings were revealed that the PBF is applied in Rwamagana District Health Centers, the PBF has the remarkable positive effects on Health Centers Performance, the staffs were good satisfied and motivated by PBF as the most factor of staffs motivation among others, the correlation between variables was the most significant and motivated (r = 0.771, P < 0.01).

Preconception care needs among female patients of childbearing age in an urban community pharmacy setting

ObjectivesTo perform a needs assessment with the use of evidence-based core indicators developed by the Preconception Health and Heath Care (PCHHC) Initiative Clinical Workgroup and Centers for Disease Control and Prevention (CDC) to describe the preconception care needs among female patients of a community pharmacy. MethodsWomen of childbearing age received a paper survey in either English or Spanish containing questions about patient demographics, health status, and pregnancy considerations. On completion of the survey, patient medication history data were retrospectively gathered from the medication profile and vaccination status on select vaccines was determined using the Michigan vaccination reporting system. ResultsNinety-nine surveys were completed. The median age was 30 years (range 18-44). Of survey participants, 77.8% indicated that they were sexually active, 70.7% had an abnormal body mass index, 78.8% were missing documentation of one or more recommended vaccinations, 66.7% were not taking any form of daily folic acid supplementation, and 49.5% were using at least 1 medication with potential teratogenic effects. ConclusionA preconception health needs assessment conducted in a community pharmacy with female patients of childbearing age found multiple opportunities for intervention such as improving daily folic acid supplementation and ensuring appropriate management of medications with potential teratogenic effects. Each of the preconception care needs assessed can be addressed through services provided by community pharmacists.

Managerial Issues and Challenges of Manager in Muhammadiyah Health Center (AUMAKES), Yogyakarta, Indonesia

The aim of this study is to investigate the managerial issues and challenges of managers in Muhammadiyah Heath Center, Yogyakarta Indonesia. Questionnaires and interview based method was used for collecting data and focus group disscussion (FGD) was applied for explore valuable information. 29 participants from Mother and child Hospital of (RSIA) ‘Aisyiyah Klaten and 40 participants from Hospital of (RS) PKU Muhammadiyah Bantul were involved. They are top managers and employees from various fields of expertise. The results showed that the leadership and management skills (finance, human resources (HR), quality, medicine information systems and equipment) of top manager is (likert scale ≥ 3) while the middle and lower managers considered not sufficiently competent (likert scale ≥ 2). The Lack of competency and leadership skills of managers will affect to management of the organization, effectiveness of the organizational structure, planning, and monitoring at every stage of management. It can be conclude that hospital manager competencies are still basic and need to be upgraded in some aspects.

Relationship between Cadres Counseling about Diarrhea to Handling Child Diarrhea

Diarrhea is the second leading cause of death in children under five years, about 760, 000 children die every year from diarrhea. Most people who die of diarrhea are actually due to severe dehydration and fluid loss. The handling of diarrheal diseases in the community both in the management of cases and for prevention is well controlled, but the problem of diarrheal disease is still a relatively big problem. The purpose to analyze relationship counseling cadres of health about diarrhea to handling child diarrhea. This research used descriptive quantitative method with cross sectional approach. The sample were cadres which follow health counseling to handling children diarrhea in Public Health Centre of South Purwokerto that is 48 people. Sampling technique used by simple random sampling. Data analysis using Spearman's Rank correlation. Media of counselling used audio visual and demonstration about diary management. Spearman's Rank correlation test results obtained p value = 0.001 (<α = 0.05) which means H0 rejected and H1 accepted, so that there is a relationship between health counseling cadres and handling of children diarrhea in Public Heath Centre of South Purwokerto. Cadres who follow counseling well able to handle diarrhea children better by 67%. Handling of diarrhea in children is done in simple non-pharmacotherapy. The counseling cadres about diarrhea effectively to handling of children diarrhea in Public Health Centre of South Purwokerto. The importance for cadres health education program to the handling of diarrhea in children, so hopefully this program can be sustainable.