Secondary Care Facilities Research Articles

Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach.

BackgroundWeak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries.MethodologyThe present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care.ResultsA total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities.ConclusionThere is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.

Pantawid Pamilyang Pilipino Programı Nakit Teşvik Uygulamasının Kent Merkezinde Yaşayan Ailelerin Sağlık Hizmetlerine, Okul Ve Aile Gelişimi Temelli Yapılan Görüşmelere Ulaşabilmesinin Etkileri

Aim: The study determined the effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program in terms of family attendance to health consultations, school and family development sessions in an urban community. Methods: A cross-sectional study was conducted among Pantawid Pamilyang Pilipino Program Filipino families with a total sample size of 124. An assisted interview was done and the data were analyzed using Stata 14. Results: Among 124 respondents, seventy percent were housewives, 35 finished secondary education with median income of 400 pesos ($7) daily. Out of 381 pregnancies, there were 342 and 39 pregnancies before and after implementation. All pre and post-natal check-ups attended by a physician. Childbirth were in secondary and tertiary health care facilities. Preventive health check-ups for children were reported only in 45 children aged zero to five years old. Deworming were received twice a year by 261/264 children 6-14 years old. There were 96% enrolled in school for the academic year 2018-2019 and 92% receive elementary education. Family development sessions included topics of wide variety. Conclusion: Overall, the Pantawid Pamilyang Pilipino Program beneficiaries were compliant with conditionalities of the cash transfers. Mothers were seen and giving birth in health care facilities while children are receiving preventive medical care and education. Keywords: preventive health services, health promotion, cash incentive plans, Pantawid Pamilyang Pilipino Program, Philippines

Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities

Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities

Obesity Beliefs and Its Treatment: Insights from a Mixed Method Study in Overweight and Obese Patients and Health Care Personnel at Secondary Health Care Facility, Nigeria (OR08-04-19)

ObjectivesBackground: Overweight/obesity is a problem in Nigeria and roll out of treatment programmes at secondary health care level is a priority.Objective: This research aimed to compile a profile of behaviours and moderating factors for the development of a weight loss intervention. MethodsTwo groups of patients were recruited from outpatient clinics at secondary health care facilities. Group 1 (n = 328) completed a questionnaire on socio-demographics, medical history, body image, food choices and physical activity. Group 2 (n = 18) completed an in-depth interview on weight loss concepts/body image. Height and weight of both groups were measured. Six health care personnel were involved in key informant interviews. Quantitative data (QtD) were analysed with SPSS and in-depth interviews (qualitative = QID) with Nvivo. ResultsAbout 40% of survey respondents were overweight and 60% obese; 44.4% of in-depth interview respondents were overweight and 55.6% obese. Physical inactivity (55.8% inactive), low fruit/vegetable intake (consumed ≤ 2 times/day), high fat meat intake (consumed > 1 time/day) and large carbohydrate staple portions (consumed 2 times/day) were identified as key target behaviours (QtD). Moderating factors include underestimation of weight (QtD, QlD), satisfaction with current size although overweight/obese (QlD), co-morbidities and not obesity per se identified as problematic (QID), lack of insight in the role of physical inactivity (QlD), poor knowledge of healthy eating (QtD), too comfortable and relaxed, resulting in over-eating (QlD) and no control over body size (genes, God’s will) (QlD).From the health personnel perspective (three physicians, two matrons and one nutritionist) (QlD), only few recognised obesity as a disease. Obesity was not routinely screened for except it is obvious, partly due to lack of tools/skills. Lifestyle modification was mentioned as treatment but only the context of treatment of hypertension and type 2 diabetes mellitus. ConclusionsConsiderations for intervention development are poor food choices, physical inactivity, satisfaction with a large body size and not recognising obesity as such and lack of understanding of causes of obesity. Funding SourcesPostgraduate Academic Mobility for African Physician Scientists (PAMAPS), EU-PhD sponsorship.

ABC-VEN Matrix Analysis of the Pharmacy Store in a Secondary Level Health Care Facility in Arbaminch Town, Southern Ethiopia

: Objective: This study was aimed to analyze Arbaminch Secondary level Hospital inventories by using ABC-VED matrix analysis and to identify the medicines requiring strict management control. Method: The ABC, VEN and ABC-VEN matrix analysis of the medicines used by Arbaminch Hospital, Arbaminch, Ethiopia for the year 2015-2017. Results: The medicine store inventory of Arbaminch Secondary Level Hospital consisted of a total of 218 products. The total annual drug expenditure of the store on products issued in 2013-2015 was found to be 259049.4 USD. In the year 2015-2017, 15.14%, 22.47% and 62.39% items were placed into A, B and C category medicines respectively, costing to 70.08 %, 19.87% and 10.05 % of drug expenditure. On VED analysis, 31.19%, 67.43% and 1.38% products were placed into the vital, essential and non-essential categories and the hospital had spent 45.05%, 52.62% and 2.33% of drug expenditure respectively. On ABC-VEN reconciliation analysis, 39.91%, 59.17% and 0.92% medicines were in group I, II and III respectively and amounting for 80.86%, 18.79% and 0.35% of drug expenditure respectively. Conclusion: The study showed that medicines belonging to category I need strict inventory control, also medicines belonging to categories II and III which need control by middle and lower managerial level respectively. ABC-VEN techniques should be applied for efficient use of resources and taking away of wastage and out-of-stock in the secondary level health care facility.Key words: ABC analysis, ABC-VEN analysis, Pharmacy store, Secondary Level, VED analysis.

GUNSHOT WOUND TO THE NECK: NOT AN EASY AIRWAY

Introduction: Securing the airway is the first and most important part in any trauma as per the Advanced Trauma Life Support (ATLS) guidelines, and an injury to the face and/or neck can lead to devastating results if the airway was not secured. Objective: A penetrating neck injury can be a life-threatening event if the airways were not secured. Case Report: 26 years old female patient was transferred to our Emergency Department (ED) from a rural secondary care facility, for a self inflicted, close range, GSW to the thyroid cartilage by a low velocity firearm. An attempt of oropharyngeal intubation was unsuccessful and as the patient’s saturation was dropping, the surgeon present in the rural ED elected to expand the entry wound and insert the tube directly through the trachea and transfer the patient to our tertiary care center. Conclusion: Securing the airways remains the most critical and challenging part even for the most skilled emergency physicians. At least a second and third alternatives should be prepared and ready in case of failure of intubation.

May Measurement Month 2017: an analysis of blood pressure screening in Hungary-Europe.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. The cardiovascular mortality rate in Hungary is twice as high as the European Union average. In a recent Hungarian screening programme, among those volunteers who claimed to be healthy, BP was above 140/90 mmHg in 24% and 39% in women and men, while the control rate was 45% and 36% in women and men, respectively. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. In Hungary, 97 sites were set-up in primary and secondary care facilities, in pharmacies and in malls. All regions, both cities and villages were involved. A total of 3967 individuals were screened. After multiple imputation, 2052 subjects (51.8%) had hypertension. 553 (22.4%) of untreated individuals had hypertension, and 666 (44.5%) of treated individuals had uncontrolled BP. More than 50% of the screened cohort had hypertension (treated and controlled, treated and uncontrolled or untreated). By identifying almost one-third of the screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, the Hungarian part of MMM17 suggest that opportunistic screening can identify significant numbers with raised BP.

PG-5 Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care workers in Federal Capital Territory, Abuja, Nigeria

Background: HIV/AIDS infection in the health care facility is a major health problem in resource limited settings. Health Care Workers (HCW) are caring for a large number of HIV infected patients. This makes them exposed to HIV infection, warranting the use of Post Exposure Prophylaxis (PEP) for HIV very critical. Here we assess Knowledge, Attitude and Practice of HCW towards PEP for HIV. Methods: This study was cross-sectional and was conducted among health care workers in 20 health care facilities providing primary health care, secondary, tertiary and private care in June 2018 under the US President Emergency Plan For AIDS Relief (PEPFAR). Data was collected using self-administered questionnaire. Results were summarized in percentages, median and Interquartile range (IQR). Results: A total of 195 HCWs completed the survey, 74 (37.9%), 34 (17.4%), 46 (23.6%) and 41 (21.1%) from Primary health care, private, secondary and tertiary health care facilities respectively. Majority of the HCWs were females, 128 (66.7%), 134 (70.2%) were aged 18–39 years and 66 (34.4%) were nurses. The median number of patients seen daily was 28 (IQR 20–50) and the median number of years in practice was 8 (IQR 4–12). One hundred and seventy-seven (92.7%) HCWs had heard of PEP for HIV and 107 (58.5%) had excellent/good knowledge about PEP for HIV. Majority of HCW 168 (92.8%) had good attitude and would recommend PEP for HIV to others; 150 (81.5%) of HCW consider themselves to be at risk and 88 (46.1%), had occupational exposure. Among those exposed, 75 (85.2%) screened for HIV. One hundred and sixty-three (86.7%) of the HCW are aware of hospital policy after occupational exposure and 107 (57.6%) would recommend commencing PEP for HIV within 1–72 hours after exposure; 131 (72.4%) are satisfied with current HIV infection protocol at their facility while 177 (92.7%) feel that more training is required for staff on HIV prevention. Conclusions: Majority of HCW had excellent/good knowledge, favorable attitude and practice towards PEP for HIV. There is need for policy makers in health sector to put policies, guidelines and pogram that will rapidly scale up PEP for HIV services in health care settings. This is much more important given the increased need for staff at these facilities to multitask and can self-expose. Keywords: Health care workers, Post exposure prophylaxis, HIV.

PG-4 Self-reported occupational exposure to HIV and Knowledge, Attitude to Post Exposure Prophylaxis among Health Care Workers in Federal Capital Territory, Abuja, Nigeria

Background: Health care workers (HCW) face major occupational exposures to the human immune deficiency virus (HIV) and other blood borne infectious agents. Not much is known about factors that predict correct and effective practice of management of such exposures. This study was conducted to determine the prevalence and types of self-reported occupational exposures to HIV among HCWs, and factors that influence the practice of managing such exposures by the HCWs. With PEPFAR emphasizing epidemic control, the HCW must know how to prevent occupational exposure. Methods: A cross-sectional study was conducted among HCWs in 20 health care facilities providing primary, secondary, tertiary and private care services in Federal Capital Territory, Abuja, Nigeria in June 2018. Data was collected using self-administered questionnaire on occupational exposures in the last 12 months and situations the exposures occurred. Results were summarized in percentages, median and interquartile range (IQR). Results: A total of 88 HCWs who had at least one occupational exposure completed the survey, of which 37 (42.0%), 18 (20.5%), 16 (18.2%) and 17 (19.3%) were from primary, private, secondary and tertiary health care facilities respectively. Majority of the HCWs were females 58 (67.4%), 61 (71.8%) were aged 18–39 years and 33 (37.9%) were nurses. The median number of patients seen daily by HCWs was 30 (IQR 20–60) and the median number of years in clinical practice was 9 (IQR 4–14). Of 88 HCWs who had at least one occupational exposure, 51 (57.0%) had experienced at least one occupational injury in the past 12 months, 70 (82.4%) were screened and followed up for HIV after occupational exposure. Among those who did not screen for HIV, half of them had assumed the patient was HIV negative or of no risk. Thirty-seven (43%) of HCWs had experienced exposure through needle stick injury, 20 (23.3%) had splashing of blood or bodily fluid on mucosal surfaces, 23 (26.7%) had both needle stick injury and splashing of blood or bodily fluid on mucosal surfaces and 6 (7.0%) had other exposures. Exposures were experienced during the following circumstances: Setting up IV line (25, 31.6%), during surgery (22, 27.8%), giving injections (23, 29.1%), collecting blood samples (31, 39.2%), recapping needles (23, 29.1%), during delivery (28, 35.4%), others (4, 5.1%). Eighty-one (94.2%) of the HCWs had heard about Post Exposure Prophylaxis (PEP) for HIV, while only 49 (55.7%) had PEP for 28 days. Conclusions: Majority of HCWs had experienced at least one occupational exposure during the past 12 months, with the highest frequency being needle stick injuries and/or splashing of blood or bodily fluid on mucosal surfaces. There is the need for improved knowledge of the risk of HIV transmission and provision of health education on occupational exposure. This will strengthen healthcare workers' practices to manage occupational exposure. Keywords: HIV, Occupational exposure, Health care workers.

Predictors of non-adherence to antiretroviral therapy among HIV patients in secondary health care facilities in Kano State- Nigeria: a case-control study.

IntroductionTreatment success requires both a sustainable supply of Antiretroviral Therapy (ART) to clinics and lifelong adherence to treatment by patients. Poor adherence to medication may lead to treatment failure as a result of developing HIV resistance strains. Based on WHO 2014 guideline, over 26 million people will be additionally enrolled globally. Optimal treatment requires identification of patients with suboptimal adherence for targeted intervention. The aim of the study was to determine the predictors of non-adherence to ART.MethodsAn unmatched 1:2 case-control study with 68 cases using simple random sampling. A case was defined as an ART patient who failed to achieve increase in CD4 count of 100cell/mm3 in one year. Controls are those with adequate immunological response. Questionnaires were administered for socio-demographic and adherence-related information. Bivariate and multivariable logistic regression was done using Epi Info at 95% Confidence Interval (CI) and precision of 5%.ResultsA total of 204 patients were enrolled, mean age of cases was 36 (Standard Deviation Sd=8.8), n=68 and controls 37 (Sd=9.8), n=136. Of enrollees, 69.6% (142) were females. Mean duration on ART was 4.9 years for cases and 4.5 years for controls (standard deviation = ± 2.2 years). The commonest reason for missing drugs was forgetfulness (58% cases). On multivariate analysis, having formal education (Adjusted Odds Ratio [aOR] = 3.03, 95% CI = 1.5-6.0) and income above minimum wage, (aOR = 2.38, 95% CI = 1.06-4.76) were independently associated with non-adherence. The commonest reason for missing drugs was forgetfulness (58% cases).ConclusionIn conclusion, educated people and those with higher income were more likely to be non-adherent and should be the focus of adherence counseling. Some form of reminders like use of telephone should be adopted to address forgetfulness.

Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D

ObjectivesTo present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition.MethodsSocio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants’ socio-demographic characteristics and clinical condition.Results907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75–0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife.ConclusionThis study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.

Alterations to embryonic development and teratogenic effects induced by a hospital effluent on Cyprinus carpio oocytes

Hospital functioning generates a great quantity of contaminants, among which organic materials, heavy metals, and diverse pharmaceuticals are noteworthy that can affect organisms if they are not properly removed from the effluents. The hospital effluent evaluated in the present study came from IMSS (Instituto Mexicano del Seguro Social) Clinic 221 in downtown Toluca, State of Mexico, a secondary care facility. The contaminants identified in hospitals have been associated with deleterious effects on aquatic organisms; however, it is necessary to continue with more studies in order to be able to regulate the production of said contaminants which are generally dumped into the city sewage system. The present study had the purpose of evaluating the alterations to embryonic development and teratogenic effects on oocytes Cyprinus carpio after exposure to different proportions of hospital effluent. For said purpose, the physicochemical properties of the effluent were determined. Concentrations of the main microcontaminants were also determined. An embryolethality study out and the determination of the main alterations to embryonic development and teratogenic effects produced, due to exposure of C. carpio at different proportions of the effluent, were carried out. The results showed that the physicochemical properties were within the values permitted by Mexican regulation; however, the presence of contaminants such as NaClO, metals, anti-biotics, anti-diabetics, non-steroidal anti-inflammatory drugs, hormones and beta-blockers, was detected. Lethal concentration 50 was 5.65% and the effective concentration for malformations was 3.85%, with a teratogenic index of 1.46. The main teratogenic alterations were yolk deformation, scoliosis, modified chorda structure, tail malformation, fin deformity and mouth hyperplasia. A high rate of hatching delay was observed. The results suggest that the hospital effluent under study is capable of inducing embryotoxicity and teratogenicity in oocytes of C. carpio.

WhatsApp an informal learning and communication tool: Perception of medical officers working in low resource setting: A Focus Group Discussion.

To assess if WhatsApp communication improves clinical knowledge and to explore the perception of its use among medical officers at a secondary care facility. The mixed method study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan Hospital for Women and Children, Kharadar, Karachi, from May to July,2018, and comprised medical officers working at the secondary care facility. All the officers were added to a WhatsApp group with a consultant. Information regarding patient condition and management were exchanged in the form of messages, images related to patient care along with consultant feedback. A pre-test to assess prior knowledge was done followed by a post-test after three months of WhatsApp communication to see improvement in knowledge. To inquire about participant's WhatsApp experience and perception, a focus group discussion was conducted. SPSS 19 was used for data analysis. There were 10 medical officers in the study. A total of 520 communications were recorded. Of them 352(67.6%) were text messages, 117(22.5%) were images followed by 15(2.88%) web links and 36(6.9%) social messages. The pre-test mean score was 29.8±2.65 while the post-test score was 41.3±2.83 with a mean improvement in knowledge of 11.50±2.46 (p<0.0001). The focus group discussion indicated that the participants felt it was a valuable tool for prompt communication and effective patient care, and enhanced their clinical knowledge. WhatsApp was perceived as an effective tool for good communication as well as for improving clinical knowledge among medical officers working in low-resource setting.

Tuberculosis screening among pregnant women attending a tertiary care hospital in Puducherry, South India: is it worth the effort?

ABSTRACTBackground: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018.Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers’ perspective.Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted ‘presumptive TB’: any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes.Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision.Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

Job satisfaction and burnout among oral healthcare providers within the Unified Health System in Sobral, Ceará, Brazil.

The particular characteristics of oral health care might influence job satisfaction and occurrence of burnout among providers, with consequent impact on their quality of life and the quality of care delivery. In the present study, we analyzed job satisfaction among oral healthcare providers affiliated with the public health service in Sobral, Ceará, Brazil, work-related factors and prevalence of burnout. Cross-sectional study performed in 2017 with 95 oral healthcare providers allocated to primary and secondary care facilities. We administered a sociodemographic questionnaire, the Occupational Stress Indicator scale and the Maslach Burnout Inventory-Human Services Survey. The data were analyzed by means of the χ2 test; the significance level was set to p<0.05. Job dissatisfaction was associated with precarious working conditions and lack of professional recognition; satisfaction was associated with interpersonal relationships. The overall prevalence of burnout was low (1.05%), however, on subscale analysis 37.9% of the participants exhibited low personal accomplishment and 22.1% high emotional exhaustion. The results for job dissatisfaction and burnout subscales point to the need for more thorough investigation of the working conditions of oral healthcare providers.

Diabetes-related Distress and Self-care Practices among Patients attending two Secondary Care Hospitals in Lagos - A strategy for tailored Interventions

Background: The challenges of diabetes mellitus are huge. Keeping up with the daily requirements of a life-long chronic illness is rigorous.Objectives: This study assessed diabetes-related distress and self-care practices and determined the extent to which they impact each other. Methods: This was a cross-sectional descriptive study carried out among patients attending follow-up diabetic clinic of two secondary health care facilities in Lagos over a three-month period. One hundred and seventy-six type 2 diabetes patients that met the inclusion criteria were consecutively recruited.Patients’ diabetes-related distress and self-care practices were assessed using a interviewer-administered questionnaire that incorporated two validated measures - The Diabetes Distress Scale (DDS17) and the Summary of Diabetes Self-care Activities (SDSCA: 11 items). Data were analyzed using descriptive and inferential statistics. P-values of &lt; 0.05 was considered significant. Results: Of the 176 respondents, 70% were females, 73.9% were 51 years and above and 67% had poor glycaemic control (FBS=135.7 ± 47.48mg/dl). The mean score for Total Diabetes Distress (TDD) is 2.89 ± 0.90. Majority (64%) viewed emotional burden (3.30± 1.38) and regimen-related distress (3.35± 1.45) as moderate distress. Dieting was adequate among respondents with “Special diet” being the most frequently practiced (3.58±1.73 days/week). Dieting is associated with total diabetes distress, emotional burden, regimen-related distress and physician-related distress (˂0.001). Regimen-related distress is also associated with glycaemic control (p=0.037). Conclusion: Diabetes distress and low self-care practices are common and impact each other. Targeted interventions incorporating emotional support and effective communication is critical.

Assessment of Infrastructural and Human Resource for Health Status and Readiness for HPV Vaccination in Rural Communities in Nigeria

Introduction: Human papillomavirus vaccination remains an important primary preventive measure for cervical cancer. Its inclusion in preventive messages and service provision by first-line health care workers in low- and middle-income countries needs to be routine. However, there is paucity of data on willingness by health care workers (HCWs) working in rural communities, to counsel and/or provide service to beneficiaries of HPV vaccination programs. This study evaluated available facilities for cervical cancer prevention and willingness to vaccinate daughters for HPV by these HCWs. Materials and Methods: This was a descriptive, cross-sectional study among HCWs in all the primary and secondary health care facilities in the three local government areas of Ibarapa health zone of Oyo state, Nigeria. Descriptive statistics such as mean ± SD, frequency and proportion were used for socio-demographic data, awareness and willingness to vaccinate daughters by the study population. Results: We observed that despite good awareness about cervical cancer (79.1%), awareness about HPV vaccine (41.9%) and their availability in Nigeria (31.0%) were low. Also, the uptake of the vaccine was low (1.8%). However, the majority of the respondents (78.6%) were willing to vaccinate their daughters. This, we believe, can be leveraged on the opportunity of already existing structure for childhood immunization in 77.8% of the facilities where the respondents practise. Conclusion: It is important that narrowing of an existing gap between awareness of cervical cancer and practice of cervical cancer prevention should be initiated. Provision of more cervical cancer prevention educational programs and HPV vaccination opportunities will be key to achieving this.

Anemia among pregnant women attending antenatal clinic at a secondary health care facility in district Faridabad, Haryana

Background: India confronts a high burden of anemia among pregnant women, that contributes to significant morbidity and mortality for mother and child. Anemia Mukt Bharat strategy launched by Government of India envisages provision of variety of facility-based interventions for management of anemia in pregnancy. Secondary care hospitals prescribe injectable iron treatment for moderate anemia and blood transfusion services for severe anemia. Objective: To estimate the magnitude and severity of anemia among pregnant women when they presented themselves for the first time at the antenatal care clinic of a secondary care hospital so as to forecast adequate supplies of medicines for managing anemia. Materials and Methods: This was a descriptive study using routinely maintained hospital clinical records during the years 2013–2015. It was conducted in a subdistrict hospital, Ballabhgarh in Faridabad district of Haryana state. Hemoglobin (Hb) level was routinely measured at first visit for all pregnant women using BC-3000 plus autohematology analyzer. Anemia in pregnancy was considered when Hb concentration was Results: The Hb level at first visit was available for 13,467 women during the study period. The mean Hb level (standard deviation) was 9.3 g/dL (1.3). The proportion of anemic pregnant women was 91.3% (95% confidence interval [CI]: 90.8, 91.7). The most common category of anemia was moderate anemia 62.5% (95% CI: 61.6, 63.2). Conclusion: We found a very high prevalence of anemia in pregnant women presenting to a secondary care setting of a North Indian hospital during their first visit to the facility during the antenatal period.

Maternal mortality: Lessons of the millenium development goals, a way forward

Maternal mortality: Lessons of the millenium development goals, a way forward

Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study.

PurposeIn rural areas, the management of hospitalizations and emergency department (ED) visits is an important issue, and it is compounded by factors such as the long distance to secondary care facilities, funding difficulties in many rural medical institutions, and shortage of medical staff. While better patient experience (PX) has been shown to reduce hospitalizations and ED visits, previous studies have not considered the differences between urban and rural areas. In addressing this gap, this study examines the association between PX and hospitalizations/ED visits on isolated islands.MethodsThis prospective cohort study was conducted on 5 isolated islands in Okinawa, Japan. We assessed the PX of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was hospitalizations and ED visits in a year. We used a mixed effect model to adjust clustering within islands and individual covariates.FindingsOf 1,258 residents, 740 responded to a questionnaire for PX measurement. There were 73 hospitalizations and 62 ED visits. Adjusting for confounding and geographical clustering, hospitalizations had significant positive association with the PX score of each patient. ED visits were not associated with the total score of the JPCAT.ConclusionOn the isolated islands, PX in primary care had positive correlation with hospitalizations. The contrast of our findings to those of previous studies may be due to the close patient‐doctor relationship on isolated islands.