Preferred Home Research Articles

Assessment of Knowledge, Dietary Habits and Nutritional Status among Mansoura University Students

Nutritional status of undergraduates is a priority to ensure a sustainable healthy adulthood, which is affected by their nutritional knowledge, dietary habits and activity. However, there aren't sufficient national research and epidemiological investigations in this area. This study aims to estimate nutritional knowledge, relevant habits and nutritional status among undergraduates. A randomized stratified survey of 658 students (37.5% males and 62.4% females), aged 17 to 25, were chosen from Mansoura university (Agriculture ,Commerce and Nursing colleges).Students filled out a self-reported questionnaire about nutritional knowledge, dietary practices and nutrition assessment. Anthropometric measurement height, weight, and BMI were assessed. Data were statistically analyzed. A Suggested master meal was designed on scientific balanced basis to meet almost of the daily dietary needs that suit this age group, which composed of all nutrients. Results revealed that, students of normal BMI were a majority (56.5%) as (21.2% males compared to 35.3% females). Right nutritional knowledge formed (78.1%), fair nutritional attitude (80.7%) was detected among students. Eating habits demonstrated (51.8%) eating meals regularly. Students announced that daily consumption of breakfast (45.3%), soft drinks (76.6%) and snacks (32.2%). Also, students preferred home (40.7%) as eating site. Results illustrated that, students don't apply healthy diet habits even with good knowledge. Although most of the students are in normal weight, our findings indicate weight gain and bad dietary habits linked to moderate nutritional knowledge which needs investigation to reduce tendency to gain weight and maintain healthy eating habits. Also public educational program in healthy diet practices should be applied.

Differences in health seeking behavior of animal bite patients between urban and rural areas of Aurangabad city

Background: The present study explores the variation in epidemiology and treatment seeking behavior of animal bite patients in rural and urban areas. The rural urban differences would be imperative in effective policy making, planning and implementation of preventive and control measures.Methods: This cross-sectional study was carried out in 50 urban patients were from anti-rabies vaccination clinic of government medical college Aurangabad and 50 rural patients from areas of Paithan from January 2016 to May 2016. All patients were subjected to socio-demographic profile and detailed history of animal bites, wound toileting and treatment including both active and passive immunization.Results: Overall, 66% were males and 34% were females. Most of the people in rural area were bitten by stray dog (42%) followed by wild animals like pig, monkey (16%) as compared with 38% of stray dog bite cases in urban areas. The commonest site of animal bites was found to be lower limb followed by upper limb, trunk and head in both areas. Maximum cases belonged to category III (84%) in rural areas followed by category I (10%). Also, most of the rural patients (46%) preferred home remedies of treatment i.e. application of oil, salt, red chilies, and turmeric paste applications as compared with 10% urban patients.Conclusions: Our study revealed that majority of the patients from rural areas were inflicted upon by stray dogs (54%) and relied more upon home remedies thereby reporting late to government hospitals.

Care preferences of healthy, middle-aged adults in Japan and the USA if they acquired dementia: A cross-sectional observational study.

Japan introduced dementia-friendly initiatives into its national policies to help people with dementia remain involved in society for as long as possible. However, some people might choose to live in a nursing home to avoid care burden on family members. Understanding middle-aged adults' preferences for place of care and identifying factors that influence their preferences would help policy decision-makers promote dementia-friendly initiatives. The present study aimed to investigate the care preferences of middle-aged adults if they acquired dementia in Japan and the USA. We carried out a cross-sectional observational study using an internet-based questionnaire survey of Japanese residents with Japanese ethnicity, Japanese Americans, and non-Asian Americans aged 40-70 years. A total of 301 participants, including 104 Japanese residents, 93 Japanese Americans and 104 non-Asian Americans, completed the survey. Participants were asked to answer the items based on a hypothetical situation in which they had acquired dementia requiring regular care and supervision. Participants preferred nursing home care (29.9%), followed by professional home care (19.6%), family home care (17.6%) and hospital care (11.3%). Japanese residents had a significantly lower preference for professional home care than did Japanese or non-Asian Americans (adjusted odds ratio 0.28, 95% confidence interval 0.10-0.75). Between-ethnicity difference in care preferences was not observed. A low preference for professional home care among the middle-aged adults might be influenced by country-specific long-term and dementia care systems. Policy decision-makers should develop professional home care services that are more available for families of people living with dementia. Geriatr Gerontol Int 2019; 19: 829-833.

Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital.

Background: Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. Objective: To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. Design: Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD. Palliative care contact was identified by Z51.5 or stop code 353. Results: Only 0.5% to 2% of living patients received palliative care, increasing abruptly at death (6%). Lower diffusion capacity for carbon monoxide (DLCO) (greater emphysema) was associated with palliative care contact, independent of comorbid disease burden or age. Initial outpatient contact was associated with a longer duration of palliative care (P = .003) and death in a home-like setting. Outpatient palliative care was associated with more severe airflow obstruction (forced expiratory volume in 1 second, percent predicted [FEV1%]), whereas greater disease exacerbation frequency was associated with inpatient contact. COPD patients not referred to palliative care had a greater comorbid disease burden, similar FEV1%, fewer disease exacerbations, and a greater DLCO. Conclusion: Few patients with COPD received palliative care, similar to national trends. Initial outpatient palliative contact had the longest duration of care and death in the preferred home environment. The extent of emphysema (DLCO reduction) and more frequent disease exacerbations identified in patients were more likely to receive palliative care. Our study begins to define the benefits of palliative care in advanced COPD and confirms underutilization in the years before death, where a prolonged impact on the quality of life may be realized.

Parent Preferences Regarding Home Oxygen Use for Infants with Bronchopulmonary Dysplasia

To determine parent preferences for discharge with home oxygen in infants with bronchopulmonary dysplasia. This was a prospective study of parents of infants born at <32weeks' gestation with established bronchopulmonary dysplasia and approaching neonatal intensive care unit (NICU) discharge. Parents were presented a hypothetical scenario of an infant who failed weaning to room air and 2 options: discharge with home oxygen or try longer to wean oxygen. The initial scenario risks reflected a 1.5-week difference in NICU length of stay and no differences in other outcomes. Length of stay and readmission outcomes were increased or decreased until the parent switched preference. Three months after discharge, parents were asked to reconsider their preference. Differences were analyzed by χ2 or Kruskal-Wallis tests. Of 125 parents, 50% preferred home oxygen. For parents preferring home oxygen, the most important reason was comfort at home (79%). Forty percent switched preference when the length of stay difference decreased by 1week; 35% switched when readmission increased by 5%. For parents preferring to stay in NICU, the most important reason was fear of taking care of the child at home (73%). Thirty-two percent switched preference when the length of stay difference increased by 1week; 31% switched when readmission decreased by 5%. One hundred ten parents completed the 3-month follow-up; 80 were discharged with home oxygen. Seventy-eight percent would prefer home oxygen (97% who initially preferred home oxygen and 60% who initially preferred to stay in the NICU). Parents weigh differences in NICU length of stay and readmission risk similarly. After discharge, most prefer earlier discharge with home oxygen. Earlier education to increase comfort with home technology may facilitate NICU discharge planning.

Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital.

EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions. Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey. From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement. Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.

Smartphone-based home screening tests for male infertility.

Diagnostic testing for male infertility has traditionally been limited to andrology labs. The advent of home-based semen testing has the potential to allow patients to perform testing in the comfort of their home and screen those who need a formal evaluation. An extensive review of the literature was performed. There are several FDA-approved devices for home semen testing. The mechanism of the test and the results provided differ by test. The existing tests are limited in their diagnostic capabilities but may fill a niche for men who do not have access to andrology lab testing or prefer home testing.

WOMEN PREFERENCE FOR PLACE OF DELIVERY IN BANGLADESH: BANGLADESH DEMOGRAPHIC HEALTH SURVEY’ 2014

ABSTRACT Although Bangladesh showed development in improving maternal health in the previous year, but delivery care is not advanced more. This research tried to discover the preference of place of delivery and determinants associated with delivery services at public hospitals. The purpose of this study was to observe the preference of place of delivery and to determine some factors for public medical as a place of delivery in Bangladesh. The data used in this analysis were gathered from Bangladesh Demographic and Health Survey’ 2014. From the analytical point of view, this study was based on percentage distribution, cross table analysis and binary logistic regression. The result explored that most of the home delivery (77.50%) took place at rural area. Among the home delivery Chittagong region (20.20%) showed the highest percentages. The people of Barisal (9.50%) went to public medical for delivery very few compare to other regions. Most of the childbirth of Dhaka region (22.90%) occurred at private clinic. Higher educated mothers (4.40%) did not like to deliver their child in home. Mothers having no formal education less went to public hospital (9.70%) and private clinic (4.40%) than others. Primary educated women had a 93% higher preference to go to public medical more than illiterate women (OR=1.930; 95% CI: 1.182-3.150). Housewife respondents (74.10%) gave birth at home mostly. Most of the home delivery (53.60%) were preferred by those mothers who had lowest wealth index. They went to public hospital (29.90%) very little in number and only 14.90% in private clinic for childbirth. Women with middle wealth status (OR= 1.989; 95% CI: 1.446-2.736) preferred to go to public hospital more than poor women. It was almost same for rich women (OR= 1.731; 95% CI: 1.297-2.309). Around 53.70% home delivery chose by those mothers who did not watching television. Respondent who were less 20 age than had 87.00% choice for home delivery. Mothers having birth order number 2-3 wanted home delivery compared to other mothers. Moreover, respondents who took no prenatal care by qualified doctor (55.30%) preferred home delivery. Otherwise they went to public medical or private clinic for delivery care. They were 67.5% higher preference to go public hospital than institutions. Access to health care in governmental medicals should be made easy. Public hospital need to grow more caring attitude for delivery. This particular area of safe delivery needs a great concern to change public attitude and raise awareness. Keywords: Place of delivery, Childbirth, Women, Mother and Bangladesh. Abbreviations: CI: Confidence Interval; OR: Odd Ratio; TBA: Traditional Birth Attendant; WHO: World Health Organization, BDHS: Bangladesh Demographic and Health Survey; MDGs: Millennium development goals; MOHFW: Ministry of Health and Family Welfare.

Accessibility, utilisation and acceptability of a county-based home care service for sick children in Sweden.

BackgroundHome care service (HCS) for sick children is a complex healthcare service, which can be organised in various models. Despite the possibility to support family everyday life, the accessibility and utilisation may still be limited. The aim of this study was to (i) determine characteristics in referrals to county‐based HCS, (ii) determine characteristics of referred children and (iii) assess acceptability of parents and children in county‐based HCS.MethodsData on characteristics of referrals and referred children were collected from medical records of children 0–17 years of age, referred to eight HCS units during 2015–2018. Data on parental and child overall experience, satisfaction of, safety with, and preference for care, were collected from parents by a questionnaire. Descriptive and comparative statistics were used to analyse the data.ResultsThree hundred and fifty‐five referrals led to one or more periods of HCS for 171 children in various ages with a wide range of illnesses. Children with cancer (30%) composed the largest group and administration of intravenous antibiotics accounted for 56% of the care tasks. Seven per cent of the referrals were to palliative home care. Thirty‐eight referrals of 34 children were refused. There was an uneven distribution of the indication for referral, acceptance rate and diagnoses of children among HCS units. Parents reported their and their child's experience with the HCS visit as highly positive and preferred home care to hospital care in over 96% of the HCS in 212 visits.ConclusionCounty‐based HCS constitutes a supplement to hospital care for sick children with various illnesses through different stages of acute and long‐term illness and at end of life, with high levels of acceptability. Few referrals and variation in referral characteristics and acceptance rate of referrals between HCS units led to unequal and inequitable accessibility and utilisation of HCS.

Prevalence of Internet addiction and its associated factors among female students at Jouf University, Saudi Arabia

Background and objectivesInternet addiction is an increasing problem among university students worldwide. The Internet provides numerous educational advantages, but too much Internet use can lead to unfavorable outcomes such as social isolation and poor academic achievement. The objectives of the present study were to assess the prevalence of Internet addiction and its associated factors among female students at Jouf University, Saudi Arabia.MethodsA cross-sectional study using a multistage proportionate sampling technique was done. A self-administered questionnaire was distributed to the female students of Jouf University during face-to-face interviews with them. This questionnaire consisted of two parts; the first is a structured one for identifying sociodemographic features, and the second is Young’s Internet Addiction Test (YIAT) to assess Internet use among the students.ResultsAccording to the YIAT scale of Internet addiction, 48.6% of the students were scored to be average Internet users. However, 49.5% and 1.9% of the students had moderate and severe addictions, respectively. The vast majority of students (94.6%) preferred home to access the Internet. Communication was the main purpose of using the Internet as it was reported by 47.3% of the students. The majority of the students (79.5%) utilized mobile phones for Internet access while other devices such as a laptop, tablets and desktop were used by 15.4%, 4.3%, and 3.2% of the students, respectively. More than half of the students (54.6%) used the Internet for an average of more than 4 h every day. Also, more than half (51.4%) used it in the evening being the dominant time of using the Internet. Internet addiction was significantly higher among students with high father education, students who sleep 6 h or less, students who utilize the Internet for entertainment purposes, and students who utilize the Internet mainly in the midnight.ConclusionNearly half of female students at Jouf University have moderate or severe Internet addiction. The significant predictors of Internet addiction were sleeping hours ≤ 6, midnight as the dominant time for utilizing the Internet and using the Internet for entertainment purposes.

Complementary Medicine & Spirituality: Health-Seeking Behaviors of Indian Immigrants in the United States.

Over 3 million India-born immigrants live in the United States, yet their health-seeking behaviors are little understood. Information on health and access to care was collected from 20 adult Indian immigrants living in the United States. Participants preferred complementary and alternative medicine home remedies to address their health needs, although they accessed health services more quickly for their children. They also reported barriers in using insurance and accessing healthcare.

Burnout Among Staff in a Home Hospital Pilot

BackgroundBurnout affects large portions of the healthcare workforce and is associated with increased medical errors, decreased patient experience and adherence, loss of professionalism, and decreased productivity. Little data exists on how novel clinical care settings might impact burnout. We studied the experience and burnout of staff involved in a home hospital pilot, where acutely ill patients were cared for at home as a substitute for traditional hospitalization.MethodsWe analyzed evaluations completed by home hospital staff (physicians, registered nurses, and research assistants) at the conclusion of a 2-month pilot program. Our primary outcome was burnout evaluated by the Mini Z Burnout Survey. Secondary outcomes included overall job satisfaction, work environment, workload, and team evaluation measured on a 5-point Likert scale.ResultsEight of nine (89%) staff completed evaluations. Seven of eight (88%) staff had no symptoms of burnout; one (13%) was under stress but did not feel burned out. Median overall satisfaction with home hospital was 4.5/5.0 (interquartile range (IQR), 1.0). Most staff (6/8; 75%) “strongly agreed” that their professional values were well-aligned with the program. Three of six (50%) “entirely” or “very much” preferred home hospital to their standard clinical setting. Six of eight (75%) staff felt that their opinions were “entirely” heard; four of eight (50%) felt the team “entirely” valued each of its participants.ConclusionsNovel clinical care settings like home hospital may lead to low staff burnout, high job satisfaction, and a healthy work environment. Further study is warranted.

Evitar la violencia obstétrica: motivo para decidir el parto en casa.

Objectives This study aims to identify the reasons why couples prefer home over hospital birth. Methodology The methodology is an ethnographic qualitative research design carried out in the Alicante Province between 2009 and 2014. Eleven couples that had had at least one planned home birth took part in the study. Twenty-one in-depth interviews and two life stories were carried out and five written records were obtained. For the analysis of the results, we relied on ethnography, the structural-dialectic model, and the software package ATLAS-ti v6.2. Results Three categories were identified: values, beliefs, and wishes. Among the values, it was highlighted that the participants were socially committed and critical with the system. The men were protective, respectful and participative, while the women were highly empowered, confident in their intuition and their capacity to give birth. They believe that delivery is a natural process that usually proceeds normally, a family act and a meaningful moment. Concerning home birth, they consider that there is less risk, their wishes are respected, and the father has a bigger role, contrary to what happens in a hospital birth. Participants wished to continue the tradition and for their rights to be respected and avoiding obstetric violence. Conclusions With their decision, these couples manifested their disagreement with some beliefs rooted in society and thus they refused hospital birth. When comparing the attention received both at home and at the hospital, they chose home birth to avoid obstetric violence and to have their beliefs and values respected.

Antenatal care practice among Pregnant Women in a selected rural area of Bangladesh

Background : Antenatal care (ANC) is an important determinant of high maternal mortality rate and one of the basic components of maternal care on which the life of mothers and newborn babies depend.&#x0D; Objective : To study the Antenatal care practice among pregnant women in a selected rural area.&#x0D; Methodology : This descriptive cross-sectional study was conducted among pregnant women in a selected rural area from July 2016 to December 2016. Total sample was 121. Purposive sampling technique was followed. Data collection was done by face to face interview by using pretested structured questionnaire. Data was analyzed by SPSS version 17.0.&#x0D; Results : A total of 121 women were interviewed. Sixty nine (57.02%) pregnant women were registered for ANC. Among them 47(68.11%) of respondents completed more than 4ANC visits. For the current pregnancy 56(46.28%) preferred Upazila Health Complex (UHC) and home delivery was preferred by 34(28.09%) respondents. Among the respondent age group 25-30 yrs were 61(50.41%) and educated upto primary level were 59(48.76%). Monthly income between 5000-10000 taka was among 48(39.66%) respondents. Most of their husbands (52.06%) were educated up to primary level and 25.61 % of them were garments worker and 23.96 % were day laborers.&#x0D; Conclusion : ANC practice was not satisfactory. Only half of the pregnant women attended for ANC and completed minimum four visits. Nearly half of the pregnant women preferred UHC. Educated women from lower economic status were found to attend for ANC.&#x0D; Northern International Medical College Journal Vol.10(1) Jul 2018: 339-342

No Place Like Home? Disentangling Preferences for HIV Testing Locations and Services Among Men Who Have Sex with Men in China

In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that “home” was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that “home” was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.

Development of a Quantitative Assessment System for Upper Limb Motor Disorder in Occupational Therapy

Many stroke patients nowadays prefer home rehabilitation, which limits their access to proper rehabilitation equipment, treatment, or assessment by therapists. Currently, the rehabilitation programs neglect to maintain a patient’s motivation in doing rehabilitation exercises. The programs also lack a monitoring system to evaluate the patients’ performance quantitatively although this is the most crucial element in rehabilitation. In order to solve these problems, we have developed a novel measurement system for upper limb motor disorder rehabilitation using an optical sensor. This system consists of an optical sensor device, a personal computer and a computerized calculated program for upper limb locus position. The optical sensor detects the user’s motions and calculates position and velocity. The sanding block position, velocity and the motion length of the block during the sanding task of five subjects with motor function disorder were measured. The accuracy of the trajectories was similar in all the actual measured subjects. These outcomes have a potential for the development of rehabilitation training programs and evaluation methods.

Enteric Fever in Cambodia: Community Perceptions and Practices Concerning Disease Transmission and Treatment

.Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture–confirmed enteric fever patients and purposively selected key informants. Informants were theoretically sampled based on initial themes identified using abductive analysis. Nvivo 11 was used for thematic coding. An urgent need to address health literacy concerning the transmission of enteric fever was identified, as lay informants did not link the disease and its symptoms to bacterial contamination of foods and drinks but rather to foods considered “bad” following humoral illness interpretations. As a result, lay informants considered recurrence of enteric fever preventable with appropriate dietary restrictions and Khmer traditional medicines. This study also reveals pluralistic health-care–seeking behavior. For initial and mild symptoms, patients preferred home treatment or traditional healing practices; limited household finances delayed treatment seeking. When symptoms persisted, patients first visited drug outlets or private practitioners, where they received a mix of nonessential medicines and one or more antibiotics often without prescription or confirmation of diagnosis. Inappropriate use of antibiotics was common and was related to diagnostic uncertainty and limited finances, factors which should be addressed during future efforts to improve the uptake of appropriate diagnostics and treatment of enteric fever.

Home-Based Infusions for Inflammatory Bowel Disease From the Provider and Patient Perspective

Introduction: Biologic therapies for IBD include infusions typically administered in hospital settings. Home-based infusions are an alternative site of care associated with lower cost. We evaluated preferences and attitudes of patients and providers around decision-making related to site of care delivery for biologic infusions using conjoint analysis, a form of tradeoff analysis that determines how respondents make complex decisions by presenting them with competing scenarios. Methods: Patients and providers in the Crohn's and Colitis Foundation's multicenter IBD Qorus quality of care network were invited to participate online. Participants rated site of care attributes using conjoint analyses. In addition, providers rated additional variables they would want reported from home-based infusions. Multivariable regression was performed to identify factors associated with preferences Results: 317 patients (62% female) completed the survey. Over two thirds were currently on a biologic medication, including 37 who had experienced both in-hospital and home-based infusions. Of these, 73% preferred home infusions. In the conjoint analysis, patients prioritized travel time and personal cost per infusion, while proximity to an emergency room and risk of reactions were less important. Among providers (n=14), 86% had prescribed home infusions; none reported severe reactions at home, but 17% had patients who had experienced a mild infusion reaction at home. Provider concerns about home infusions included ordering pre-medications and less patient contact. Providers wanted more clinical information from the home setting including disease severity, weight changes, medication compliance, and patient concerns. In the conjoint analysis, providers prioritized a history of infusion reactions and presence of anti-drug antibodies when considering site of care; patient preferences were least important. Multivariable regression associated household income, travel time, and out of pocket cost per infusion with patient preferences for site of care. Conclusion: Most patients prefer home infusions, primarily based on convenience and financial considerations. Providers had concerns around decreased patient contact and medication ordering, and wanted additional information relayed back to them. When considering site of care, providers prioritized safety concerns over patient preference and cost,

Non-use of Janani Avam Bal Suraksha Yojana in a district of Bihar: ensuring safe deliveries needs strategy modification

Background: India’s Janany Surakhsha Yojana (JSY) is the largest conditional cash transfer (CCT) program in the world in terms of the number of beneficiaries - covering about 9·5 million (36%) of 26 million women giving birth in India. Eleven States/UTs including Bihar, are still below the National estimate for institutional delivery of 78.9% (NFHS 4). In this study we attempted to find out the status of institutional and home deliveries in district Arwal of Bihar and reasons why in spite of cash incentives a proportion of mothers are opting for home delivery.Methods: A cross sectional descriptive design was used to interview 407 women, who had given birth to a child in previous one year. Focuss group discussions was held with community and health staff to corroborate the interview data.Results: Fifty nine percent of mothers were found to have preferred home delivery over institutional one. Reasons which came to light were home deliveries are cheaper (24.1%), unawareness about JSY (22%), unavailability of transport to reach hospital (22%) and better care being taken at home delivery (20.1%) variables. Older age, having a BPL card, and literacy of husband were found as favoring institutional delivery whereas dissatisfaction during a previous abortion or a livebirth in hospital were both associated with non-use.Conclusions: Better client awareness, strengthening of public health infrastructure, availability of skilled birth attendants at health subcentres (HSCs) and emergency transport in time can reduce number of home deliveries and lead to success of JBSY programme and subsequent reduction in maternal morbidity and mortality.

Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors.

BackgroundIncorporating patients’ preferences in the care they receive is an important component of evidence-based practice and patient-centred care.ObjectiveThis study assessed stroke patients’ preferences regarding rehabilitation settings.MethodsA cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics.ResultsSixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred the community. Age and source of finance were significantly associated with preferences. The majority (66.7%) of those aged ≥ 65 years expressed a preference for rehabilitation in the home or community (X2 = 6.80; p = 0.03). Similarly, most of the participants (53.3%) who depended on family finances preferred home- or community-based rehabilitation, while most of those who depended on employment income for finances preferred an outpatient rehabilitation setting (X2 = 16.80; p = 0.01).ConclusionA preference for rehabilitation in outpatient facilities predominated followed by home-based rehabilitation, and preferences varied based on age and source of finance. These variations in preferences have implications for making rehabilitation decisions.