Peripheral Health Institutions Research Articles

Structural quality of reproductive health services in South-Central Ethiopia

Background: The quality of health services has been known to be grossly deficient in developing countries, but only few studies were carried out to document the deficiencies in a systematic manner. Objective: To assess the quality of reproductive health services in rural settings with emphasis on the structural aspect. Methods: This is a descriptive cross-sectional study conducted in the peripheral health institutions of two administrative zones in South-Central Ethiopia. Data were collected using an interview questionnaire and observation checklist adopted from the WHO Safe Motherhood Need Assessment and the WHO training modules for EPI and STDs. Findings: Multiple structural deficiencies were identified in all components of reproductive health care. Adequate amounts of the absolute minimum equipment required for maternity and neonatal care were not available in many health institutions. Sterilizers were available in 11(15.3%), essential drugs like iron tablets in 14 (19.4%), and ergometrine injection in 48 (66.7%) of the health institution. In the EPI section, refrigerator was available in 57(79.2%) and steam sterilizer in 43(59.7%) of the institutions. Mix of contraceptives was not available widely. Important laboratory tests like syphilis test, were available in only one (1.4%) health institution. Only 8(11.1%) health institutions had adequate IEC materials on all national reproductive health components. (Ethiopian Journal of Health Development, 2000, 14(3): 317-326)

Validity of case-finding tools in a national tuberculosis programme

For case-finding under the District Tuberculosis Programme (DTP) in India, the recommended method is sputum smear microscopy of chest symptomatics attending the health institutions on their own. It is universally followed, with a slight variation in the procedure of initial screening of outpatient attendance respectively at the District Tuberculosis Centre (DTC) and at peripheral health institutions (PHI). However it may be argued that smear microscopy of all patients with chest symptoms results in a high workload in terms of positivity rate for examinations done as well as for its comparatively lower predictive value of negativity. It would be interesting in this context to estimate validity of screening and diagnosis obtained under operational conditions. The data available from some of the field surveys and from the DTP situation have been analysed for the above purpose. Examined in the context of statistical reliability of tests, the methodology of prior X-ray screening adopted by the DTC for case-finding for tuberculosis appears to be well founded. In contrast to the DTC, the need for X-ray screening at PHIs does not arise, as the procedure of patients being subjected to screening for the presence of chest symptoms has in itself a very high specificity of about 97%. The results show that X-ray and smear microscopy should not be used indiscriminately as case-finding tools in mass case-finding programmes, as their predictive values of positivity are likely to be very low at the current case prevalence rates in the community, being 2–8 per thousand.