Public Sector Hospitals Research Articles

Stigmatization and Self-Perception regarding issues related to Mental Health: A qualitative survey from a lower and middle-income country.

To assess the understanding of the patients with common mental disorders, towards issues related to their mental health. This qualitative study was conducted from December 2018 to April 2020. Thirty-four patients, suffering from common mental disorders, were interviewed in public and private sector hospitals of Peshawar. The interviews were recorded, transcribed, translated into English, and themes were generated from their responses. Content analysis was carried out on the data obtained. The themes resulting from each interview were then further comparatively analyzed. The mean age of the sample was 31.9±10.61 years. Most of the patients (n=24, 70.6%) were aware that the nature of their illness was a psychological one with a majority (n=17, 50%) describing it with the symptoms of headache or burden on the head. Most of the patients (n=14, 41.1%) were unaware of the general public opinion towards mental disorders but those who were aware described these with stigmatizing descriptions e.g., "people call them crazy" etc. Most of the patients (n=20, 58.8%) were unaware about their own opinion regarding their illness and some said that they tried to conceal their illness from others. Unfortunately, most of the patients (n=19, 55.8%) were not aware of mental healthcare professionals or the existence of psychiatry as a profession. Stigma, both public and personal, was quite high, which caused patients to feel compelled to conceal their illness. There was also a general lack of knowledge with regard to mental disorders in our society. The general public opinion about mental health professionals was not favorable.

Financial Implications for Families of Newborns Admitted in a Tertiary Care Neonatal Unit in Northern India

Background Admission of a newborn to neonatal intensive care unit is very stressful for family and poses significant financial burden. Aim To estimate the cost of neonatal care in a tertiary care level institution in northern India. Methods This prospective observational study was conducted over a period of 4 months at a 30-bedded level III neonatal unit in a tertiary care institute in north India. Data was collected from a self-written diaries by parents of all neonates admitted in the unit. The cost analysis included direct hospital cost and additional expenditure by families during entire hospital stay. Results A total of 135 newborns (86 males) were enrolled in this study. 60 babies required Neonatal intensive care unit (NICU) admission. The median total expenditure incurred in study cohort was US$172 (IQR 83.5–546.3); median duration of hospital stay was 7 (IQR 5–16) days. The total expenditure per day for babies with Neonatal intensive care unit stay was US$32.7 (IQR 23.5–48). The direct hospital charges amounted to approximately 3/4th of total expenditure, while rest 1/4th was additional cost incurred upon family. Conclusion The cost of care of a sick newborn in public sector hospital of India is substantial. Additional expenditure apart from direct cost of treatment contributes significantly to the financial burden.

Real-Time Surveillance of Dog Bite Incidence in Islamabad: A Cross-Sectional Study from December 2019 to July 2020

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of <0.05. A total of 338 dog bite cases were captured in the World Veterinary Service (WVS) application, and most cases (n = 226, 85.6%) were reported in December 2019 with a male-to-female ratio of 2:1. Most cases were reported from the age group of 22 to 31 years (n = 178, 53%). Out of the total number of cases, 263 (78%) presented with a single anatomical location, and 174 (51%) had Category II wounds. All dog bite patients were given only the first dose of the anti-rabies vaccine at the hospital level. Real-time dog bite surveillance via a mobile-based application proved to be effective for the timely recording and management of dog bite cases. Young people were reported to be mostly affected by dog bites, and nearly half of the cases were managed in hospitals. Refresher training was conducted for medics and paramedics for mobile-based applications, dog bite management, and proper referral of cases to tertiary care hospitals.

Analysis of Reported Dog Bite Data in Government Hospitals of Various Districts in Punjab, Pakistan

Background: Rabies is a neglected and underestimated national public health issue in Pakistan. Freeroaming dogs are the principal reservoir and also potentially cause thousands of dog bite injuries in different age groups of people. Objectives: The present study was designed to evaluate the burden and frequency distribution of total dog bite injuries in Punjab. The comparison of total dog bite injuries between 2019 and 2020 were made to understand whether there is significant difference in total number of dog bite injuries in 2019 and 2020. Methods: Total dog bite data from public sector hospitals of Punjab province were collected for the time period between January 2019 to December 2020 with the help of District Health Information System (DHIS) which is a comprehensively designed digital program. Descriptive measures and the graphical representation were used to describe and interpret the said data. A non-parametric test (Mann-Whitney test) was used to compare the median number of dog bite injuries in 2019 to 2020. Results: Results show that more than 0.2 million number of dog bite injuries have been recorded in 2019 and 2020. The medium number of the dog bite injuries in 2019 and 2020 were statistically significant, having pvalue

Knowledge and Practices of Dialysis Unit Staff Regarding the Care and Management of Vascular Access Infections

Background: Vascular access infections among dialysis patients are becoming the major concerns that contribute to a significant morbidity and mortality across the globe. Proper management and care must be planned according to the standard protocols for the prevention of these infections. Objective: The objective of the study was to assess the knowledge and practices of dialysis staff regarding vascular access infection control in tertiary care hospitals of Peshawar, Pakistan. Methodology: A cross-sectional study was conducted on dialysis staff including nurses and technicians (n=58). All hemodialysis staff (Nurses and Technician) was included in the study who were regularly working in dialysis unit and had at least 6 months of dialysis unit experience. Data was collected through a self-administered questionnaire and checklist with its proper validation. Data was analyzed through SPSS Version-20 for its proper presentation. Results: The finding of the study showed that around 44.94% of the questions were corrected by the nurses and technician on the knowledge assessment questionnaire while looking into their practices 28.5% of the correct practices were followed by them. Additionally it was found that private sector hospital nurses and technician scored more than public sector hospitals in knowledge and practices. Practical implication: It is one of the main responsibilities of the dialysis unit staff to have knowledge regarding vascular access infections. So based on their knowledge, they will maintain the aseptic protocol while practicing, which will ensure a low infection rate and prevent the patient from complications that will improve the patient's experience and reduce the length of stay. Conclusion: It is concluded from the research findings that nurses and technician knowledge and practices are not sufficient to prevent the vascular access infections; therefore they must be trained for the provision of best possible care among the dialysis patients. Keywords: Knowledge, Practice, Vascular Access, Infections, Dialysis, Nurse, Technicians

IMPACT OF NURSE PRACTICE ENVIRONMENT, ORGANIZATIONAL COMMITMENT ON JOB SATISFACTION AND INTENT TO LEAVE IN HOSPITALS OF PAKISTAN

Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan

IMPACT OF NURSE PRACTICE ENVIRONMENT, ORGANIZATIONAL COMMITMENT ON JOB SATISFACTION AND INTENT TO LEAVE IN HOSPITALS OF PAKISTAN

Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan

Acceptance of Telemedicine: A Perspective from the Doctors Working in the Tertiary Care Hospitals of Quetta

The pandemic of COVID-19 forced the world to reduce the social interactions and push the world toward keeping destinations. During the pandemic, the need for online health services was profoundly felt also in Pakistan. Online health services saw a boost all around the country; however, there are still many challenges in the acceptance of the online services in Pakistan yet. Objective: To assess the acceptance and adaption of telemedicine services in three public sector hospitals of district Quetta during the pandemic of COVID-19. Methods: Questionnaire was designed and distributed among 385 physicians from Civil Hospital, Bolan Medical College and Fatima Jinnah Hospital and the results were interpreted with the help of the SPSS. Results: A total of 385 respondents were selected for the given purpose. 231 were male and 154 were female. 250 of the respondents said that only the urban areas were taking advantage of the telemedicine services while due to lack of internet facilities, the people from rural areas were devoid of the online services. The results also showed that 111 doctors had started telemedicine services since the pandemic. 235 of the respondents said that the youth were more inclined toward accepting telemedicine as compared to elderly. Conclusions: Telemedicine has not seen a large-scale acceptance and yet the people are relying on conventional methods of treatment and not switching to telemedicine as largely as they should have so had the doctors.

The Incidence of burnout among Surgery, Orthopedics and Medicine residents in a Public sector Hospital of Punjab.

Introduction: Burnout among healthcare professionals is a growing concern worldwide, affecting both their well-being and the quality of patient care.Objective: This study aims to assess the occurrence and influence of burnout among surgery, orthopedics and medicine residents at a public sector hospital in Punjab, Pakistan, over a 6-month period.Methods: In this observational cross sectional study the levels of burnout were assessed using the American Public Welfare Association (APWA) inventory to measure the levels of burnout among the study participants. This study was conducted over the period of 3 months (Sept - Oct 2022) and data was collected from the residents of surgery and medicine department.Results: This study provides important insights into the well-being of surgery, orthopedics and medicine residents in a tertiary care hospital setting and highlights the need for effective burnout prevention and intervention programs. The findings of this study inform the development of strategies to support the well-being of healthcare professionals and to improve the quality of patient care.Conclusion: It underscores the need for proactive measures to support the well-being of healthcare professionals and improve the overall quality of patient care in public sector hospitals.

Cost Analysis of Intranatal Care Services at a Tertiary Care Public Sector Hospital in Rajasthan, India.

Introduction India is responsible for the second-highest maternal deaths and the greatest burden of stillbirths worldwide. The cost of intranatal services is an important determining factor, especially in developing countries like India. Most studies report the cost of delivery from the patient's perspective, but there is a lack of studies from the health system's perspective. This present study aimed to bridge this gap by estimating the overall and unit costs of various types of deliveries at a tertiary-level hospital in Rajasthan, India. Methods The cost estimation of intranatal services was conducted ina tertiary-level teaching hospital in Jaipur, Rajasthan. This cost analysis undertook the health system's perspective, using bottom-up costing methodology. Data on all the resources (capital/recurrent) used for the delivery of intranatal care from April 2020 to March 2021 were collected. Sensitivity analysis was done to account for any variability in cost components on overall intranatal service cost. Results The annual cost of intranatal care services at the tertiary care hospital was INR 149,011,957 (USD 1,988,152). The unit cost per vaginal delivery was INR 8,244.4 (USD 109.9) and the unit cost per cesarean section was INR 10,696.2 (USD 142.7).Among various heads of expenditure, 'human resource' costs were predominant, accounting for 47.7% of the total costs, followed by 'building/space' and 'overhead' costs, accounting for 30.59% and 11.1%, respectively. Conclusion The results may help plan and manage intra-natal care services in Rajasthan. Apart from the judicious utilization of resources, the findings of the study may also serve as a basis for future health economic studies.

Determinants of Work-Related Stress among Nursing Professionals

The work environment is one of the significant factors causing work-related stress. Supervising work-related stress is crucial as it is associated with the arousal of diseases, low productivity, and occupational calamities. This article aims to explore the concept of work-related stress and its determinant in nursing to understand this phenomenon. We used qualitative research methodology to examine work-related stress antecedents among nurses in public sector hospitals. Ten semi-structured interviews were conducted with nurses, and themes were extracted. An interpretive approach was applied for data analysis. Criticism and abuse from physicians, violence from colleagues, violence from patients, unmanageable workload, unpredictable staffing and scheduling, and gender discrimination are the primary sources of stress for nurses in public sector hospitals. Nurses experience stress ascending from the work environment's psychological, physical, and social facets. Stress reduces performance capacity, low efficiency, and lack of concern for colleagues and the organization.

#5841 UTILITY AND ACCEPTANCE OF TELENEPHROLOGY AMONG KIDNEY TRANSPLANT RECIPIENTS IN A PUBLIC SECTOR HOSPITAL IN A DEVELOPING COUNTRY

Abstract Background and Aims The importance of telemedicine in delivering renal health care has come to light during the COVID-19 pandemic. Moreover, specialist care to transplant recipients is often limited to urban areas especially in developing countries. Telenephrology offsets this discrepancy enabling quality care to patients in rural areas. But, apart from availability, the true success and future of telenephrology depends primarily on patients’ acceptance. This study was performed to assess the feasibility, patient attitude and acceptance of telenephrology services among renal transplant recipients at our institute, a public sector hospital in a developing country. Methods This single-centre cross-sectional study included renal transplant recipients who availed our telenephrology services for at least 3 months. A total of 100 transplant recipients were selected by stratified random sampling from the list of attendees of telenephrology consultation and included in this study. The study questionnaire was administered in local language by the telephone interview method. Results The mean age of our study cohort was 32.83 ± 9.96 years (16 – 55yrs) and 92% were males. The median number of teleconsultations availed by the patients was 5 (1-20). The questionnaire was answered by the patient himself/herself in 89% cases, spouse in 7% and children in 3% cases. Only thirty-nine (39%) patients were graduates or post graduates. Over one-half (51%) of the patients belonged to the lower-middle socioeconomic class as per the modified Kuppuswamy classification. Prior to initiation of the telenephrology service, the median distance travelled to attend our out-patient department (OPD) was 304.5 Km (6 – 1673 km). Most (87%) of our patients used public transport to attend OPD. Three-fourths (79%) of the patients were accompanied by family members for their OPD visit. Attendees incurred productivity loss due to missed work days in 57% of the cases. The median cost of each OPD visit was 3000 (40-15000) INR. Almost all the transplant recipients felt that Telenephrology service was a right approach during the COVID-19 pandemic. 98% of the patients said that they were confident discussing their complaints over phone while 99% of our patients were comfortable sharing reports over phone. Majority (>90%) of the patients gave a satisfaction score of 4 (out of 5) for their telenephrology experience. The most important benefit (79%) of telenephrology as perceived by the transplant recipients was financial benefit of avoiding travel and workdays saved. Regarding the problems faced during teleconsultation, 22% patients responded that they wish to see the doctor in person to feel satisfied; 5% had problems with availability of investigations locally. Only a small fraction (2%) of patients had difficulty in explaining symptoms over a tele-consult. A significant (97%) patients felt that Telenephrology services should continue in combination with physical OPD services. Conclusion Telenephrology is feasible and acceptable to kidney transplant recipients irrespective of literacy status across all socio-economic classes. In developing countries like India, telenephrology has immense potential to provide quality nephrology care.

Descriptive Cross-Sectional Study on Blood Disorder and Lung Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease due to smoking. It is avertable as well as treatable. COPD is a one of the main cause of morbidity and mortality affecting developed and developing countries. We aim to estimate burden of anemia at a tertiary care public sector hospital. Methods: This is a descriptive cross sectional study, done at JPMC Karachi in 2014. All COPD patients admitted in medicine and pulmonology departments were enrolled in this study. After informed consent, data of complete blood count was accessed from medical record and anemia was labeled as per operational definition. Data analyzed by SPSS version 16.0. Frequency and percentage proportion of qualitative variables, mean and standard deviation of numerical values were calculated with P value <0.05 was taken as significant. Results: Of 137 cases, 118(86.13%) were males and 19(13.87%) were females while male to female ratio was 6.2: 1. The average age and weight of the patients was 58.31±12.17 years and 59.36±10.56kg, similarly average duration of disease and hemoglobin of the patients was 5.69±4.42 years and 12.34±1.58 mg/dl respectively. 37.96% (52/137) patients were anemic in our study. Rate of anemia in COPD patients was not significant among age groups (p=0.076) and with duration of disease (p=0.22). Conclusion: Anemia seems to be a common feature in COPD (37.96%), mechanisms involved in the genesis of anemia in COPD are poorly studied. Low hemoglobin level can have adverse effects on certain respiratory parameters in COPD, increasing morbidity and mortality.

Organization Citizenship Behavior: Mediation towards Leadership Styles and Employees Engagement at Workplace in healthcare through the Lens of Social Exchange Theory

This research study explores the role of OCB on leadership and employee engagement. The aims of the study was to investigate the mediating role of organization citizenship behavior on the leadership styles and employees’ engagement at work place in health organizations through the lens of social exchange theory. A structured questionnaire has been prepared strictly in line with the extracted variables and guidelines for questionnaire construction. The primary data was collected through a closed-ended questionnaire, distributed among healthcare professionals in Lady Reading Hospital Peshawar and Shifa International Hospital Islamabad. The Bivariate correlation and multiple regressions were used in this study and the result shows a significant relationship between variables. The study found partial mediation between variables during analysis. Yet, the results and findings are only valuable for Pakistani healthcare institutions because data was collected from public and private sector hospitals in Peshawar and Islamabad.

Trend and Reasons of Women Towards the Choice for Place of Delivery: Evidence from Mics 2017-18 Punjab, Pakistan

Objective: To assess the attitudes and reasons of women towards the choice for place of delivery as per the data from the Multiple Indicators Cluster Survey (MICS) 2017-18, Punjab, Pakistan. Material and methods: Observational Study conducted at 36 districts of the Punjab, 2017-18A total of 53,840 households were drawn as the sample size from 2,692 sample clusters, out of which 1,893 were rural clusters and 799 were urban clusters. From 53,840 households, 52,765 households occupied and 51,660 were successfully interviewed. Therefore, the response rate was 97.9%. According to survey results, 79,510 women had been eligible for interview of age group 15-49 years. Out of which 74,010 women were interview successfully with the response rate 93.1%. Further, out of these 74,010 women, there were 26,980 women who had ever or currently married, and out of these women 15,656 women gave birth in the last two years. In our study, we considered the place of delivery as an outcome variable and wanted to identify the associated socio-demographic and socioeconomic characteristics that were expected to be responsible for shifting the trend from the public to the private sector for delivery. To check the association and for statistical testing of hypothesis, Chi-square test for association was applied. We also applied multinomial logistic regression to identify the predictors for the place of delivery by using SPSS. P-value ?0.05 was considered as significant. Results: Majority of the women (43.5%) delivered their babies in the private sector while (29.7%) of women delivered their babies in public sector hospitals, and (26.4%) women prefered home delivery. In the comparison of area of residence, urban women compared to rural women were more likely to choose public sector hospitals for their deliveries OR=1.02 (0.94-1.09) 95% CI, p=0.000, for home deliveries OR=1.293 (1.154-1.45) 95% CI, p=0.000 and for other OR=2.341 (1.196-4.582)95% CI, p=0.013. In the comparison of regions of Punjab, the women of South and Central Punjab were more likely to choose private sector hospitals for delivery, OR=1/0.535=1.87 (0.478-0.600)95% CI, p=0.000 and OR=1/0.624=1.61 (0.564-0.690)95% CI, p=0.000, respectively. The women who get antenatal care had 2.84 times more chances, as compared to the women who did not get antenatal care visits, to deliver in the private sector OR=0.353 (0.213-0.538)95% CI, p=0.000. About the model fitting, chi-square value=3527.06, Cox & Snell=0.202 and p=0.000 suggested that the predictors in the model had a significant effect. Conclusion: Overall women prefer to undergo childbirth process in private sector hospital while women of urban area prefer public sector hospital. It may be related to facilities present in private sector hospitals or it may due to the fact that public healthcare facilities are not accessible to everybody especially in rural areas. In modern era, still many women prefer home delivery.

PMMA Cranioplasty Making by Using Open-Source CAD Software, PLA Printers, and Silicone Rubber Molds: Technical Note with Two Illustrative Cases.

We read with great interest Malikov et al's case report/technical note entitled “PMMA cranioplasty making by using open-source CAD software, PLA printers, and silicone rubber molds: technical note with two illustrative cases.”[1] We were the first in the literature to begin an ultra-low-cost patient-specific polymethyl methacrylate (PMMA) cranioplasty implant service in Pakistan, that too in a public sector hospital, and we have already published our technical note and limited case series with 1-year follow-up.[2] Since then, our technique has been adopted by our colleagues at neighboring centers, and we have amassed an experience of over 50 cases, and many of our patients are in long-term follow-up. At the national level, the lowest cost offered by commercial companies for a patient-specific PMMA implant exceeded US$ 1,000 and US$ 10,000 for titanium and polyetheretherketone (PEEK) hemicraniectomy implants, respectively. The vast majority of the Pakistani population are poor and underprivileged, and the trauma cohort who require this operation are actually those who could never meet these costs in their lifetime. Free-hand PMMA cranioplasty was utilized in virtually all cases nationally. After beginning our initial service, the total cost to manufacture an implant in consumables was US$ 40. The printer we used was a locally assembled Chinese Prusa i3 clone. Thus, production cost was exponentially cheaper than commercial rates, and in our experience, our clinical and aesthetic outcomes are the same, if not better. Naturally, when one intends to offer a service for the patient benefit rather than profit, affordability is one of the most important parameters, especially in the impoverished developing world. We would be delighted to know the exact specification of the printer used by Malikov et al, the cost of disposables and printing of each implant, and the context of this cost in their patient's socioeconomic demographic/health care system, and whether commercial options were as extortionate for their general public as it was for ours.

Compliance With the World Health Organization Surgical Safety Checklist at a Tertiary Care Hospital: A Closed Loop Audit Study.

The WHO launched the "Safe Surgery Saves Lives" campaign in 2008 to improve patient safety during surgery. The campaign includes the use of the WHO Surgical Safety Checklist, which has been proven effective in reducing complications and mortality rates in several studies. This article discusses a clinical audit at a tertiary healthcare facility that assesses compliance with all three components of the checklist to minimize errors and improve safety standards. This prospective, observational, closed-loop clinical audit study was conducted at Hayatabad Medical Complex, a tertiary care public sector hospital located in Peshawar, Pakistan. The audit aimed to assess compliance with the WHO Surgical Safety Checklist. The first phase of the audit cycle commenced on October 5, 2022, and involved collecting data from 91 surgical cases in randomly selected operating rooms. Following the completion of the first phase on December 13, 2022, an educational intervention was then conducted on December 15 to underscore the significance of adhering to the checklist, and the second phase of data collection began the following day, ending on February 22, 2023. The results were analyzed using SPSS Statistics version 27.0. The first phase of the audit showed that there was poor compliance with the latter two parts of the checklist. Certain components of the WHO Surgical Safety Checklist were well-complied with, including patient identity confirmation (95.6%), obtaining informed consent (94.5%), and counting of sponges and instruments (95.6%), while the lowest compliance rates were in recording allergies (26.3%), assessing blood loss risk (15.3%), introducing team members (62.6%), and inquiring about patient recovery concerns (64.8%, 34%, and 20.8% for surgeons, anesthetists, and nurses, respectively). In the second phase, after an educational intervention, compliance with the checklist improved significantly, particularly for those components with low compliance rates in the first phase, marking recording allergies (89.0%), introducing team members 91.2%), and inquiring about patient recovery concerns (79.1%, 73.6%, and 70.3% for surgeons, anesthetists, and nurses, respectively). The study showed that education is a critical factor in improving compliance with the WHO Surgical Safety Checklist. The study suggests that overcoming the obstacles to implementing the checklist requires a collaborative environment and effective instruction. It emphasizes the importance of adhering to the checklist in all surgical settings.

The German Development Bank as a policy entrepreneur for social health protection: a case study of the development and implementation of the ‘Sehat Sahulat Programme’ in Khyber Pakhtunkhwa, Pakistan

Background The German Development Bank (KfW) supported the Government of Khyber Pakhtunkhwa (GoKP) to design and implement its first social health protection (SHP) scheme, named the Sehat Sahulat Programme (SSP). We described the role of KfW in the evolution of SSP with a view to identifying transferrable lessons for international development agencies working on similar initiatives in socioeconomically comparable contexts. Methods We employed a qualitative instrumental case study design approach. First, we obtained and analysed key programme documents to describe the chronology of events and policy changes. We then undertook in-depth interviews to understand factors influencing policy changes. Finally, we carried out non-participant observations to understand how policy decisions were made and implemented. We employed maximum variation sampling to recruit participants and conducted a thematic analysis of data. Results SSP was described by GoKP officials as an innovative financing strategy and a flagship project of the government formed by the Pakistan Tehreek-i-Insaf (PTI). First, programme officials reported that KfW was instrumental in both designing and financing SSP, which had plans to provide free health insurance to low-income families and raise revenue through paid enrollment of the wealthy (solidarity). Second, GoKP deviated from this model and covered the entire population of KP free of cost. Through SSP, GoKP envisaged service provision through private hospitals (subsidiarity). In the third year, GoKP included public sector hospitals in the programme. Although planned supplementary insurance products might result in inequitable utilisation, KfW continued supporting SSP and committed funding for piloting outpatient department services for two years, 2023 and 2024. Conclusions This in-depth case study has highlighted the potentially positive role of international development assistance in introducing innovative financing strategies to promote universal health coverage. However, development partners might have limited control over how things evolve.

Diagnosis of Acute Dengue Virus Infection Using Enzyme-Linked Immunosorbent Assay and Real-Time PCR.

Dengue fever is a viral infection caused by the dengue virus and is a growing concern for public health worldwide, particularly in tropical and subtropical regions. This study aimed to assess the diagnostic accuracy of a commercially available NS1 ELISA kit for dengue fever in Pakistan using multiplex qRT-PCR as the gold standard. The study recruited 1236 suspected cases of dengue fever admitted to public sector hospitals in Lahore, Pakistan. Of the suspected cases, 610 (49.3%) were confirmed positive for DENV infection through qRT-PCR, with all four serotypes detected. DENV-2 was the most prevalent serotype, detected in 95.7% of cases. The NS1 ELISA kit detected 71.1% of the positive cases. However, the diagnostic accuracy of the NS1 ELISA kit was found to be only 64.89%. Of the 610 confirmed cases, 68% were male and 32% were female, with a median age of 30 years. Dengue fever was diagnosed in 91.8% of cases, while 8.2% were diagnosed with dengue hemorrhagic fever (DHF). DHF patients had a higher prevalence of abdominal pain, hemorrhagic manifestations, and thrombocytopenia. The cocirculation of all four DENV serotypes in Lahore is concerning and could lead to more severe forms of the disease, such as DHF or dengue shock syndrome, in the future. The study highlights the low diagnostic accuracy of commercially available NS1 ELISA kits and emphasizes the importance of using molecular methods to confirm acute dengue infections. Given the increasing prevalence of dengue fever in developing countries like Pakistan, more accurate and reliable diagnostic tools are needed for effective disease management and control.

Using the COM-B model and Behaviour Change Wheel to develop a theory and evidence-based intervention for women with gestational diabetes (IINDIAGO)

BackgroundIn South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system.MethodsThe Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process.ResultsKey objectives of our planned intervention were 1) to address women’s evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods.ConclusionsThis paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. Using such tools can contribute to improving rigour in the design of behavioural change interventions.Trial registrationFirst registered on 20/04/2018, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174.