Rural Health Units Research Articles

Comparing the Professional Role and Tasks Approved in Curriculum with the Ongoing Role and Tasks of Midwives Employed in Tabriz Health Care Units

Background: Midwives play an important role in the implementation of health programs in health care units. The objective of this study was to compare the professional role and task in curriculum with the ongoing role and task of midwives working in the health care units of Tabriz (East Azarbaijan, Iran, 2015). Methods: This cross-sectional study was done via census on all midwives working in rural and urban health units in Tabriz in 2015 (225 persons). The data was collected using a researcher-designed questionnaire based on the national midwifery curriculum approved in 2012. The questionnaire includes questions related to the use of specific teaching courses and their relevancy to the professional roles contained in the curriculum;a self-assessment of the midwives’ current performance was completed by midwives themselves. The validity and reliability of questionnaire were confirmed. Data were presented using mean (SD) and n (%) for numerical and categorical variables. Results: Professional roles and tasks contained in the curriculum were not fully relevant to current roles and tasks of midwives. The highest relevancy was related to the role of education and the lowest relevancy was seen in ongoing tasks related to disease diagnosis, care and intervention. Of the specialized courses, internships in pregnancy and childbirth and its pathology had the highest and lowest applications, respectively. Conclusion: This study showed that, midwifery specialized training courses content and professional role and tasks curriculum- based are not consistent with ongoing expected real world tasks. Therefore, it is essential that reforms are made to enhance the curriculum and efficiently align it with practical responsibilities and expectations.

Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school

Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p = 0.002), came from lower socioeconomic strata (p = 0.001) and had significantly (p < 0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p < 0.001) or be generalist Medical Officers (p < 0.001) or Rural/Municipal Health Officers (p = 0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p = 0.033 and p = 0.040, respectively) and be surgical or medical specialists (p = 0.010 and p < 0.001, respectively). The findings suggest ADZU-SOM’s SAHPE philosophy manifests in the practice choices of its graduates and that the ADZU-SOM can meet the rural and urban health workforce needs of the Western Mindanao region.

Utilization of Team Building Strategies among Nurses Working in Rural Health Units

Background: People in every work place talk about building the team, working as a team, but few understand how to create the experience of team work or how to develop an effective team. Belonging to a team, in the broadest sense, is a result of feeling part of something larger than oneself to contribute to the overall success of the organization. Aim: This study aimed to assess nurses' utilization of team building strategies. Subject& method: The descriptive design was utilized to carry out the present study. This study was carried out in (11) Rural Health Units at El-Tal El-kebeer City, in Ismailia Governorate. All nurses (97) working in Rural Health Units at El-Tal El-Kebeer City, Ismailia Governorate were participated in the study. Tool of data collection: Self Administered Questionnaire Sheet was used to assess nurses' utilization of team building strategies. Results: The results indicated that majority of nurses utilized all team building strategies, especially commitment and connection strategies. There was no statistically significant relationship between age, sex, years of experience, nursing qualifications and utilization of team building strategies except cooperation strategy. Conclusion: most nurses were utilizing different team building strategies. Also, the common strategies that used were both commitment strategy and connection strategy. Recommendation: It is recommended to encourage nurses for the utilization of contribution strategy through: highlighting the talents, experiences, and accomplishment, providing professional development opportunities, participating in problem solving and decision making. Models of team building should be used inside each health unit.

Decentralizing HIV/AIDS Education in the Philippines: A Measure of Awareness from the Grassroots

The HIV/AIDS is pandemic. The study measured the level of understanding of the community on HIV/AIDS as part of measuring the impact of decentralized initiative against HIV/AIDS. It applies the Systems’ Theory of Policy Process developed by David Easton. The study showed that: age, gender, civil status and religion have nothing to do with the level of understanding of the HIV/AIDS. The study revealed that respondents’ of the issue of HIV/AIDS as measured in terms of knowledge, attitudes and beliefs fall within the median range of scores: 2.89 for knowledge, 2.59 for beliefs and 2.93 for attitudes. The study further concluded that there is no significant relationship between the personal profile of the respondents and their level of understanding. The study found that heightened understanding of HIV/AIDS among Rural Health Unit 4 respondents was due to decentralized mass information and dissemination campaign of the Local Government Unit.

The effect of diabetes and hypertension on work productivity and job satisfaction

Objectives The objective of this paper was to assess the effect of diabetes mellitus (DM) and hypertension on work productivity and job satisfaction. Background Work is a basic human activity through which every individual realizes their own livelihood. DM and hypertension are diseases with a high prevalence of growth globally; the question of the ability of this patient's to be productive is extremely important in terms of work productivity and job satisfaction evaluation. Patients and methods The study was a nested case–control cross-sectional study. A total of 800 participants were recruited (400 patients and 400 controls). They were enrolled from urban and rural family health units as follows: 223 DM patients, 177 hypertensive patients, and 400 participants in the control group. All the participants were interviewed using a prestructured questionnaire and their medical record was revised. The questionnaire contained an Arabic validated version of work productivity and impairment, the general health version (WPAI: GH), and job satisfaction questionnaire. Results Work absenteeism, work productivity loss, and impairment were more with the diabetic patients than with the hypertensive patients (P Conclusion DM appears to reduce an individual's ability-to-work in comparison with patients with hypertension.

Effect of an educational program for farming mothers to protect their children from pesticide exposure

Pesticides represent a major environmental hazard. The toxic effects of pesticides are a concern among high risk groups, especially children. Aim: To evaluate the effect of an educational program for farming mothers to protect their children from pesticide exposure. Subjects and method: Quiz-experimental design was used for this study. The study was conducted in general pediatric out- patient clinics at Assuit University Children Hospital. The study subjects included a convenient sample of 60 farming mothers. Two tools were developed by the researchers for data collection. Tool I: Socio- economic scale; it was developed by (Abd El-Twaab 2004). Tool II: Structure interview questionnaire: divided into two parts: Part 1 Questions to assess farming mothers' knowledge about pesticides: Part 11: Questions to assess farming mothers' knowledge about their practice regarding pesticides. Results: the mean age of the mothers was 38.8± 9.7 years. 60% were illiterate, 95% were house wife and farmer, and more than half were in the middle social class. Most of the mothers had poor knowledge and unsatisfactory knowledge about practices in the pretest. Statistically significant differences were detected between mothers' total score of knowledge and their knowledge about practice. Conclusions: Most of the mothers had poor level of knowledge and unsatisfactory knowledge about practice regarding pesticide in preprogram and after implementation of program, the level of mothers 'knowledge and their knowledge about practice improved. Recommendation: Medical conveys in the village for the public about pesticides by the directors of rural health units shared with professors in medicine and nursing in the university. Using mass media to disseminate correct information about pesticides and to increasing the mothers' awareness about its harmful effect on health.

A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves.

BackgroundIn Southern Ontario, climate change may have given rise to an increasing occurrence of heat waves since the year 2000, which can cause heat stress to the general public, and potentially have detrimental health consequences. Heat waves are defined as three consecutive days with temperatures of 32 °C and above. Heat stress is the level of discomfort. A variety of heat stress indices have been proposed to measure heat stress (e.g., the heat stress index (HSI)), and has been shown to predict increases in morbidity and/or mortality rates in humans and other species. Maps visualizing the distribution of heat stress can provide information about related health risks and insight for control strategies. Information to inform heat wave preparedness models in Ontario was previously only available for major metropolitan areas.MethodsHospitals in communities of fewer than 100,000 individuals were recruited for a pilot study by telephone. The number of people visiting the emergency room or 24-hour urgent care service was collected for a total of 27 days, covering three heat waves and six 3-day control periods from 2010–2012. The heat stress index was spatially predicted using data from 37 weather stations across Southern Ontario by geostatistical kriging. Poisson regression modeling was applied to determine the rate of increased number of emergency room visits in rural hospitals with respect to the HSI.ResultsDuring a heat wave, the average rate of emergency room visits was 1.11 times higher than during a control period (IRR = 1.11, CI95% (IRR) = (1.07,1.15), p ≤ 0.001). In a univariable model, HSI was not a significant predictor of emergency room visits, but when accounting for the confounding effect of a spatial trend polynomial in the hospital location coordinates, a one unit increase in HSI predicted an increase in daily emergency rooms visits by 0.4 % (IRR = 1.004, CI95%(IRR) = (1.0005,1.007), p = 0.024) across the region. One high-risk cluster and no low risk clusters were identified in the southwestern portion of the study area by the spatial scan statistic during heat waves. The high-risk cluster is located in a region with high levels of heat stress during heat waves.ConclusionsThis finding will aid hospitals and rural public health units in preventing and preparing for emergencies of foreseeable heat waves. Future research is needed to assess the relation between heat stress and individual characteristics and demographics of rural communities in Ontario.

Counseling Program for Prevention of Cervical Cancer among Women at Assuit, Egypt

Abstract Cervical cancer can affect women of all ages, but is most common in women between 30 – 45 years of age. Aim of This study was to evaluate the effect of the counseling program on prevention of cervical cancer among women. The study Design: Quiz experimental design. Setting The study was conducted at the Rural Health Unit (RHU) in El-Masara village Sample : A simple random sample of 160 women who met the required criteria were included. Study tools: An interview questionnaire was used, it consisted of 3 parts: The first part included personal data. The second part assessed women’s knowledge about cervical cancer and screening using Pap smear The third part women’s attitude about cervical cancer and Pap smear screening. Results: It was found the ages of more than one third of women ranged from 25-30 years. The majority of women had poor knowledge and negative attitude about cervical cancer in the pre- test, which improved significantly after the post-test. Conclusion & Recommendations: This study concluded that women had limited knowledge about cervical cancer and its prevention. There was a positive correlation between total ' knowledge score and attitude regarding prevention of cervical cancer. The study recommended, raise community awareness and improve their knowledge about the disease and its prevention through counseling program. Also, improve woman’s attitude towards screening Pap smear

Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: A one-year implementation study.

BackgroundEffective Prevention of Mother to child Transmission of HIV (PMTCT) relies heavily on follow-up of HIV-infected women and infants from antenatal, through postnatal, to the end of the breastfeeding period. In Uganda, postnatal (PNC) follow-up remains below 50 % creating a missed opportunity for linkage to comprehensive HIV care and early infant diagnosis (EID). We evaluated the use of HIV infected peer mothers (peers), community lay persons and Village health team (VHT) members to improve PNC follow up and EID in urban and rural health units.MethodsStudy participants were HIV-infected women recruited from antenatal clinics at three urban clinics (Mulago, Rubaga and Mengo hospitals) and one rural health centre (Mpigi Health centre IV) between January and September 2010. The women were followed through delivery and the mother-infant pairs for the 6-week postnatal visit and up to 14 weeks for EID. Peers, community lay persons and VHT members were identified and trained in basic PMTCT and reproductive health (RH). They were then assigned to study clinic to support and follow study participants, their partners and infants through provision of health education, counseling, home visits, and phone call reminders. Six week PNC attendance was measured as a proportion of mother-infant pairs that returned for the 6-week postnatal follow up visit (5–8 weeks) while EID was measured as the proportion of HIV-exposed live birth that had an HIV test done by 14 weeks of age. Data at baseline (one year before the intervention) was compared with that during the one year study period among study participants and HIV infected women and their HIV-exposed infants in the whole clinic population.ResultsA total of 558 HIV-infected pregnant women were recruited for the study, 47 mother-infant pairs were censured before 6 weeks due to stillbirth (14), infant death < 6 weeks (23), death of participant (04) and loss to follow up before delivery (6). 401/511 (78.5 %) of mother-infant pairs returned to the study clinics at six-week, while 441/511 (86.3 %) infants were tested for HIV infection by 14 weeks of age. The baseline six-week PNC follow up was 37.7 % and increased during the study period to 78.5 % and 39.1 % among study participants and whole clinic population respectively, an incremental difference of 39.4 % (P < 0.001). EID increased from a baseline of 53.6 % to 86.3 % and 65.8 % among study and whole clinic population respectively during the study period, an incremental difference of 20.5 % (P < 0.001).ConclusionsUse of peers, community lay persons and VHT members led to a significant increase in six-week postnatal follow up of HIV infected women and EID among HIV exposed infants in the four study clinics. Our study supports the use of peers to improve early postnatal follow up and EID and should be implemented in other health units to support the PMTCT cascade.

Working Through and Around: Exploring Rural Public Health Nursing Practices and Policies To Promote Rural Women’s Health

Purpose : To discuss findings from research in Ontario, Canada, that addresses the following objectives: 1) identify organizational attributes and local and provincial health policies that enable or impede the work of Ontario public health nurses to improve rural women's health, and 2) critically examine roles, job descriptions, and practices of Ontario PHNs that will improve rural women's health. Sample: 20 frontline PHNs and 14 supervisors and managers in three Ontario public health units that serve people who live in rural locations. Method : Six focus group interviews were conducted with PHNs and PHN managers in three rural Ontario public health units. Study participants were asked to describe policies and practices that guided their practice regarding rural women's health, identify organizational attributes that enable or impede public health nursing practice regarding rural women's health, and indicate roles and practices for PHNs to improve rural women's health. Findings : 1) Policies address rural women's health and rural public health minimally or not at all, 2) PHN practice is primarily focused on child bearing women and children to the exclusion of other populations of rural women such as seniors, 3) PHNs work through and around policies to address rural women' s health more effectively, and 4) institutional, government, community, professional, and personal factors play significant roles in shaping public health nursing practice and policy regarding rural women's health. Conclusions : This research facilitates understanding regarding policies, contexts, and values that shape rural PHN practice, and provides evidence for policies and practices that enhance and support public health nursing for more effective promotion of rural women's health. Clearly, more investigation is needed; this research forms the basis for ongoing inquiry in this area. Keywords : rural public health nursing, rural women's health, policy, practice, Canada DOI : h ttp://dx.doi.org/10.14574/ojrnhc.v15i1.342

Relationship between Client, Clinical Related Factor and the Level of Effectiveness of Directly Observed Treatment Short course (DOTS)

This study is a descriptive method of research which is concerned with the relationship of the DOTS client and clinical related factor to the level of effectiveness of the DOTS program. The clinical related factor provides knowledge as to the set-up of the DOTS facility. The researchers used the correlational survey design of research since the purpose of this research study is to correlate the DOTS client and clinical related factor as to the effectiveness of the Directly Observed Treatment Short course (DOTS) for tuberculosis in terms of program administration, information dissemination, diagnostic services and medical supplies, and medical follow up. The researchers used the NTPTB register of each Rural Health Unit for the list of clients who are registered under the Directly Observed Treatment Short course strategy for the fiscal year 2010 as the respondents of this study. There were eighty-two (82) DOTS client identified and diagnosed of having tuberculosis. In the analysis and interpretation of the data, frequency count, mean and percentage are employed particularly in the interpretation of the profile of the respondents and clinical related factor. Coefficient of Correlation and T-test (test of the relationship) is used in determining the influence of the profile of the client and clinical related factor to the effectiveness of the DOTS program. The findings of the study reveal that there is a significant relationship between the profile of the clients, clinical related factors and the level of effectiveness of the Directly Observed Treatment short course program of the RHU. Keywords - Descriptive Correlation, Directly Observed Treatment Short course, Clinical Related Factors, Level of Effectiveness, Zambales, Philippines

Relationship between Client, Clinical Related Factors and the Level of Effectiveness of Directly Observed Treatment Short course (DOTS)

This study is a descriptive method of research which is concerned with the relationship of the DOTS client and clinical related factor to the level of effectiveness of the DOTS program. The clinical related factor provides knowledge as to the set-up of the DOTS facility. The researchers used the correlational survey design of research since the purpose of this research study is to correlate the DOTS client and clinical related factor as to the effectiveness of the Directly Observed Treatment Short course (DOTS) for tuberculosis in terms of program administration, information dissemination, diagnostic services and medical supplies, and medical follow up. The researchers used the NTPTB register of each Rural Health Unit for the list of client who is registered under the Directly Observed Treatment Short course strategy for the fiscal year 2010 as the respondents of this study. There were eighty-two (82) DOTS client identified and diagnosed of having tuberculosis. In the analysis and interpretation of the data, frequency count, mean and percentage are employed particularly in the interpretation of the profile of the respondents and clinical related factor. Coefficient of Correlation and T-test (test of relationship) is used in determining the influence of the profile of the client and clinical related factor to the effectiveness of the DOTS program. The findings of the study reveals that there is a significant relationship between the profiles of the clients, clinical related factors and the level of effectiveness of the Directly Observed Treatment short course program of the RHU. Keywords - Descriptive Correlation, Directly Observed Treatment Shortcourse, Clinical Related Factors, Level of Effectiveness, Health Education, Zambales, Philippines

Attitude and Compliance to Newborn Screening among Mothers in Sto. Domingo, Ilocos Sur, Philippines

Newborn screening is a public health program designed to screen infants shortly after birth for a list of conditions that are treatable, but not clinically evident in the newborn period. The study determined the level of awareness, attitudeand compliance to newborn screening among mothers in Sto. Domingo, Ilocos Sur. Respondents of the study were the 95 mothers who had normal deliveriesat the Rural Health Unit from January to December 2011. Descriptive correlationalmethod of research was used, and the questionnaire–checklist was the primary tool in data gathering. The data gathered were analyzed and interpreted through the use of statistical tools. The study revealed a “high” level of awareness on NBS among the respondents. Among the socio-demographic profile, occupationwas significantly related to the level of awareness, attitude and compliance to NBS. On obstetric history, gravidity and parity were found to be significantly related to the level of awareness, attitude and compliance. Source of information did not significantly influence the level of awareness, attitude and compliance to NBS. On the other hand, the level of awareness of the respondents significantly influenced their attitude and compliance to NBS.Keywords: Social Pediatrics, health, awareness, attitude, compliance, newborn screening, descriptive-correlational design, Philippines

M-phone impact on practical training: role of m-phone as part of the educative method for training local health workers of rural areas of developing countries

As previously demonstrated, m-phones can be easily used, without any adapter, to take and send images from a microscope (Terry in Telemed and e-Health 17(5): 320–323, 2011); (Bellina and Missoni in Health and Technol doi:10.1007/s12553-011-0008, 2011). The extraordinary power of m-phone in the education of very low skilled students, illiterate and/or vulnerable subjects has been previously described (Bellina and Missoni in Telemed and e-Health 17(9): 750–750, 2011). The objective of the current study is to investigate the mechanisms generating the strong educational potential of the method, by exploring the psychological relationships brought by the use of m-phone in the learning mechanisms. A two-phase approach training was performed by using structured interviews, didactic tables, m-phones and computers as didactic tools. A total of 101 health workers have been successfully trained in basic lab skills and in the application of m-phone to capture microscope snapshot images, from September 2009 to May 2013 in limited-resource settings, such as rural health units in Uganda, Bangladesh, Afghanistan, Madagascar, Democratic Republic of Congo and Thailand. Results showed that sharing images by m-phone, together with a two-phase educational method, (phase of relation, with a personal approach to the student, and phase of contextualization, with an approach to local community problems)combined with the use of logical didactic tables, proved to be a phenomenal learning tool, immediately linked to students’ personal perceptions.

Client Satisfaction of the Reformed Health Services at Rural Health Units/ Centers

Client Satisfaction of the Reformed Health Services at Rural Health Units/ Centers

Prenatal Practices and Pregnancy Outcomes Among Primigravida Mothers in llocos Sur

The study determined the prenatal practices and pregnancy outcomes among primigravida mothers in Ilocos Sur. It looked into the significant relationship between the respondents' socio-demographic profile and prenatal practices. Significant relationship between pregnancy outcomes and prenatal practices of primigravida mothers was also determined. The study made use of a descriptive correlational type of research. A questionnaire-checklist formulated by the researchers was the main tool used to gather data. It involved 120 primigravida mothers from selected municipalities of /locos Sur, who were chosen through purposive sampling. Frequency, percentage and simple linear correlation analysis were the statistical tools used to treat the data. Majority of the respondents were 21- 25 years old, single, college graduates, plain housewives, from rural areas, with a monthly family income of Php 5,000 and below, availed of the services of the midwives for prenatal check up, at the rural health unit, once during the first trimester, twice during the second and third trimester, availed of tetanus toxoid immunization, assessment of fetal growth, fundic height measurement, iodine and iron supplementation, physical examination , laboratory examinations, and health education. Most of the respondents did not develop any complications, delivered a full term baby in the hospital through normal spontaneous delivery. Significant relationship existed between civil status and pre-natal practices along preference for health care provider; age and health education classes, occupation and physical assessment and health education classes; income and physical assessment; provision of iodine supplementation and health education: place of residence and tetanus toxoid immunization. A significant relationship also existed between provision of iodine and pregnancy outcome: hemorrhage and type of delivery; hemorrhage and health education classes; anemia and health education classes; preterm birth and abdominal palpation and health education classes. It is, then, recommended that primigravida must be encouraged to follow the desired number ofprenatal visits. Health workers in the RHU should conduct home visits to remind them of the next visits.

Dengue Knowledge and Preventive Practices among Rural Residents in Samar Province, Philippines

Background: The World Health Organization (WHO) classifies dengue as a disease important in public health. The epidemiology and ecology of dengue infections are strongly associated with human habits and activities. Aim: The present study aimed to evaluate the knowledge and practices regarding dengue infections among rural residents in Samar Province, Philippines. Methods: A cross sectional design was adopted for this investigation A convenience samples of six hundred forty six (646) residents who were visiting the rural health units in different municipalities of Samar, Philippines were taken as participants in study. Results: More than half of the respondents had good knowledge (61.45%) on causes, signs and symptoms, mode of transmission, and preventive measures about dengue. More than half of the respondents used dengue preventive measures such as fans (n = 340, 52.63%) , mosquito coil (n = 458, 70.90%), and bed nets (n = 387, 59.91%) to reduce mosquitoes while only about one third utilized insecticides sprays (n = 204, 31.58%) and screen windows (n = 233, 36.07%) and a little portion used professional pest control (n = 146, 22.60%). There was no correlation between knowledge about dengue and preventive practices (p=0.75). Television/Radio was cited as the main source of information on dengue infections. Conclusions: Findings suggest that better knowledge does not necessarily lead to better practice of dengue measures. Educational campaigns should give more emphasis on cost effective ways of reducing mosquito and preventing dengue such as environmental measures and control. Furthermore, wide range of information, skills and support must be provided by the government to increase dengue awareness among residents. Keywords: Dengue fever, dengue preventive practices, dengue knowledge, Samar Province DOI: http://dx.doi.org/10.11591/ijphs.v2i2.2511 Full Text: PDF

Dengue Knowledge and Preventive Practices among Rural Residents in Samar Province, Philippines

The World Health Organization (WHO) classifies dengue as a disease important in public health. The epidemiology and ecology of dengue infections are strongly associated with human habits and activities. The present study aimed to evaluate the knowledge and practices regarding dengue infections among rural residents in Samar Province, Philippines. A cross sectional design was adopted for this investigation. Convenience samples of six hundred forty six (646) residents who were visiting the rural health units in different municipalities of Samar, Philippines were taken as participants in study. More than half of the respondents had good knowledge (61.45%) on causes, signs and symptoms, mode of transmission, and preventive measures about dengue. More than half of the respondents used dengue preventive measures such as fans (n = 340, 52.63%), mosquito coil (n = 458, 70.90%), and bed nets (n = 387, 59.91%) to reduce mosquitoes while only about one third utilized insecticides sprays (n = 204, 31.58%) and screen windows (n = 233, 36.07%) and a little portion used professional pest control (n = 146, 22.60%). There was no correlation between knowledge about dengue and preventive practices (p=0.75). Television/Radio was cited as the main source of information on dengue infections. Findings suggest that better knowledge does not necessarily lead to better practice of dengue measures. Educational campaigns should give more emphasis dengue transmissions and on cost effective ways of reducing mosquito and preventing dengue such as environmental measures and control. Furthermore, wide range of information, skills and support must be provided by the government to increase dengue awareness among residents.

Recognition of prior learning: Credit transfer for enrolled nurses studying science in the Bachelor of Nursing program

Objective: The aim of the study was to investigate the impact of Recognition of Prior Learning (RPL), on academic achievement for enrolled nurses (ENs), who applied for credit transfer for first stage science in the Bachelor of Nursing program (BN). Design: A survey method was employed using a quantitative and qualitative approach. The design was based on a questionnaire that included three sections: demographic information; a five‑point Likert scale broken into four constructs; and free text open‑ended questions. Setting: The study was conducted from a regional nursing and rural health unit of a South Australian tertiary education institution. Main outcome: Main outcomes from the study showed the constructs of Regret, Difficulty, Advantage and Satisfaction of receiving RPL for first stage science, identified some Diploma undergraduates have difficulty in studying second stage science, whereas other Diploma undergraduates are able to grasp the concepts and are satisfied with their achievement. Results: 44.5% accumulatively of strongly disagree and disagree responses of respondents felt they were unprepared through their science education at TAFE. 33.5% of accumulative responses from respondents of strongly agree and agree identified they were prepared for second stage science through pre‑learned science at TAFE. 15% of respondents were undecided as to whether they were prepared for second stage science in the BN program. Conclusion: Applying for RPL can have an advantage for an applicant and this study has shown that some ENs entering the BN program were advantaged, while others expressed disadvantage and would have preferred to have received credit RPL in another area of the BN program rather than first stage science.

Factors Contributing to Discontinuation among Intrauterine Device Users in Zagazig City

Background: Intrauterine contraceptive device (IUD) is the most common, widely usedreversible method of contraception, currently used by nearly 160 million women. Aim: Thisstudy embarked on to explore the factors associated with intrauterine device discontinuationand failure in Maternal and Child Health Centers at Zagazig City. A descriptive design wasselected in carrying out this study and a purposive sample of 400 women who had used anIUD and requested its removal was recruited for this study. Setting: The study was conductedat 4 Maternal Child Health clinics of 4 Rural Health Units affiliated to the Ministry of Healthand population in Zagazig city .Tools: An interview questionnaire sheet was designed andimplemented. The results of the present study revealed that the mean duration of the currentIUD was 4.5±3.6 with a range of 0.1-22 years, almost three fourths (74.4%) of women lost tofollow up. The desire for conception was the most common reason, with the highestpercentage (25.5%) followed by heavy bleeding and spotting and PID (21.5% and 12.3%respectively). In addition, other reasons for IUD withdrawal was social problems, expireddate of the IUD and missed IUD (14.5%, 10.3% and 8.2% respectively). Statistical significantrelation was found between reasons of discontinuation and women’s age, education, numberof living children, the previous use of IUD and the duration of the current IUD. Conclusion:From present results it could be suggested that medical and social problems constitute themain reasons for discontinuation of IUDs. A great proportion lost the follow up and asignificant relation was found between women characteristics and reasons for discontinuationof the IUD. Recommendations: Counseling during the initial and return visits as well as afterthe removal of the IUD is mandatory.