Visiting Health Centers Research Articles

Midwives’ role in drop-out antenatal care at second visit: Therapeutic and interactive communication in the Lombok Tengah District, Indonesia

Visiting health center for getting ANC service, at least four times during pregnancy consisting of the first visit (K1) during the first trimester, the second visit (K2) during the second trimester, and K3 and K4 visit during the third trimester must be done by pregnant women in Indonesia. The objective of this research is to analyze therapeutic and interactive communication by midwives during ANC service. This observational research used cross sectional design. The sample size is 30 women with babies under six months old from 3 PHCs working areas in Lombok Tengah District. Among all therapeutic and interactive communication indicators performed by the midwives, only responsive indicator in therapeutic communication showed insignificant influence on K4 of pregnant women. The other indicators showed significant impact. More than 50% of respondents said that midwives providing ANC had poor attending skill, respect, responsiveness, empathy, informing, persuading, and reminding. The conclusion is that the worse the pregnant women perception of midwives communication behavior is, the higher the chance for the pregnant women to drop-out during K4 is.

Screening and brief intervention with adolescents with risky alcohol use in school-based health centers: A randomized clinical trial of the Check Yourself tool

Background: This study aimed to compare care delivery and alcohol and marijuana use for adolescents with risky alcohol use who received a school-based health center (SBHC) visit with and without the Check Yourself tool, an electronic tool that gives motivational feedback on substance use and summarizes results for providers. Methods: We conducted a randomized controlled trial with 148 adolescents aged 13–18 who met criteria for moderate- to high- risk alcohol use, recruited from urban SBHCs. Participants were randomized to receive their SBHC visit with (n = 73) or without (n = 75) the Check Yourself screening and feedback tool. All SBHC providers received a brief training on motivational interviewing. Results: Adolescents who received the Check Yourself tool + SBHC visit reported higher levels of alcohol (67%) and marijuana (73%) counseling from the provider during their visit, compared with those who received a SBHC visit without the tool (40% and 45%, respectively, Ps < .005), and had higher motivation to decrease marijuana use relative to those who did not (P = .02). Relative to baseline, adolescents in both groups reduced their typical number of drinks of alcohol, maximum number of drinks of alcohol, and hours high on marijuana over time (Ps < .02) at 2-month follow-up. Conclusion: When adolescent patients are given an electronic screening and feedback tool, it can prompt providers to increase counseling of adolescents with substance use risk. Overall, participants who had a visit with a trained provider reported high satisfaction with care and decreased the amount of alcohol use over 2 months, suggesting that SBHCs are an excellent venue for delivery of brief substance use interventions.

Differences in US antibiotic prescription use by facility and patient characteristics: evidence from the National Ambulatory Medical Care Survey.

Antibiotic resistance is increasing, largely due to the overuse of antibiotics. Patient demographic characteristics can influence rates of antibiotic prescription, but less research has assessed the role of facility-level characteristics. The objective of this study was to examine the prevalence of antibiotic prescriptions for viral-like illness, as well as patient and provider factors that influence antibiotic prescription practices. We conducted an observational cohort study using data from the 2012 National Ambulatory Medical Care Survey. We compared the prevalence of antibiotic prescription for all aetiologies and for viral-like illnesses between community health centres, non-community health centre clinics and emergency departments. Then, we used logistic regression models to compare the odds of antibiotic prescription use by facility and patient characteristics. Data came from 630 community health centre visits, 857 non-community health centre outpatient clinic visits and 627 emergency department visits. Compared to patients visiting non-community health centre clinics, patients visiting community health centres and emergency departments for any aetiology were more likely to receive antibiotic prescriptions. Patients with viral-like illnesses were less likely to receive antibiotics at community health centres and exhibited similar odds of receiving antibiotics at emergency departments. Certain patient demographics (age, race/ethnicity and payment source) were associated with variation in overall antibiotic prescription, but these factors were mostly unassociated with antibiotic prescription for viral-like illnesses. The care setting that patients visit may influence their odds of receiving antibiotics. Initiatives addressing overuse of antibiotics should be mindful of facility- and patient-based characteristics when designing interventions.

Peran Pendamping Program Keluarga Harapan dalam Meningkatkan Kunjungan K1-K4 Ibu Hamil ke Pelayanan Kesehatan

Background: Family Hope Program (PKH) as referred to as conditional cash transfer is a government poverty alleviation program by providing conditional cash money to induces healthy behavior especially pregnant, lactating mother and children under 5 years nutritional status in poor families. This program is assisted by field staff to facilitate PKH participants to comply antenatal care visits of pregnant mothers and improving nutritional status of children under five years. This study aims to explore the perception of PKH participants regarding the role of field staffs as a motivator, facilitator, educator, and mediator in assisting participants.Method:This is a qualitative study using in-depth interviews to nine pregnant mothers (as PKH participants) who lived in Sumbermalang, Situbondo District. The informants were selected purposively with inclusion criteria is pregnant mothers as well as their husbands who have been participating in PKH program for more than 2 years. In-depth interviews were also conducted to health providers (village midwives) and field staffs of PKH. Data were analyzed using thematic content analysis.Results: The characteristics of informants were mostly around 20-25 years old, 7-9 months of pregnancy, as housewive and husbands’ occupation was a building construction. Most informants say that the field staffs have facilitated them to improve their behavior to visit health center or village midwives to control their pregnancy, and also provided health education including motivated pregnant mother to consume ferrum tablet completely as well as other medicine. There were no obstacles arising in visiting health center to control their pregnancy and children. PKH field staff roles were necessary as a facilitator, motivator, mediator, and educator of PKH participants in order to help participants to change their behavior. Increase coordination among PKH field staffs and health workers including village midwives is needed to run this program smoothly.

Enabling Services Improve Access To Care, Preventive Services, And Satisfaction Among Health Center Patients.

Enabling services address a combination of social determinants of health and barriers to access to primary care and are intended to reduce health disparities. They include care coordination; health education; transportation; and assistance with obtaining food, shelter, and benefits. Empirical evidence of enabling services' potential contribution to health outcomes is limited, which impedes their widespread dissemination. We examined how the receipt of enabling services influenced patient health care outcomes based on a nationally representative survey of patients served in 2014 at health centers funded by the Health Resources and Services Administration. We compared enabling services users and nonusers and found that enabling services were associated with 1.92 more health center visits, an 11.78-percentage-point higher probability of getting a routine checkup, a 16.34-percentage-point higher likelihood of having had a flu shot, and a 7.63-percentage-point higher probability of patient satisfaction. Our results confirm the value of systematic delivery of enabling services in reducing access barriers and improving patient satisfaction.

Assessment of adherence to therapy and exploring of barriers and facilitators in HIV positive patients in Tabriz-Iran: a mixed method study protocol

BackgroundAdherence to therapy is a key predictor of the success of human immunodeficiency virus (HIV) treatment. There is limited information available from Iran about that and there is a need for more knowledge about factors influencing treatment adherence. The aim of this study is to examine adherence levels and to explore patients’ views about barriers and facilitators to HIV treatment adherence.MethodsThis mixed-method study with the sequential explanatory design has two phases. The first phase (quantitative phase) is a cross- sectional study to assess the in Tabriz, the sixth large city of Iran. A convenience sampling method will be used to select 150 HIV positive patients who visit health centers in Tabriz. The second phase is a qualitative study designed to explore the HIV positive patients’ views of barriers and facilitators that can affect their adherence to therapy. In this phase, purposive sampling and in-depth individual interviews will be conducted for data collection. The conventional content analysis approach will be employed for data analysis. In addition to literature review and nominal group technique, the findings of the qualitative and quantitative phases, will be used to recommend some strategies to support adherence to therapy in HIV positive patients.DiscussionThis is the first study looking into adherence to therapy and exploring of factors influencing in HIV positive patients which will be performed via a mixed-method approach, aiming to develop health practices improvement strategies. It is worth noting that there is no strategic guideline in Iran’s health system for improvement of treatment adherence in HIV positive patients. Health professionals and policy makers can be aware of factors influencing HIV treatment adherence. Therefore, it is hoped that the strategy proposed in the current study can lead to improvements their ability to treatment adherence.

Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care

There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery. This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014-2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care. Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%-50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services. Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.

PREVALENCE OF HIGH BLOOD PRESSURE SUBTYPES AND ITS ASSOCIATION WITH BODY MASS INDEX IN CHILDREN AND ADOLESCENTS IN RUSSIA

Objective: The aim of the study was to assess the prevalence of different high blood pressure subtypes in children and adolescents in Russian Federation. Design and method: Data were derived from the database of Russian Health Centers network. A cross-sectional study included the data of 107015 children (55601 boys) aged 6–17 years who visited Health Centers in more than 20 regions of Russian Federation from 2010 to 2015. The standard examination in a Health Center included measurement of height, weight, blood pressure, glucose and cholesterol level in capillary blood. High blood pressure was defined to age-, gender- and height- specific 90th percentile and above. Results: The prevalence of high blood pressure was 19.5% and 14.6% for boys and girls, respectively. Isolated systolic high blood pressure was the dominant high blood pressure subtype among boys aged 7–17 years and girls aged 8–17 years, while isolated diastolic high blood pressure was the most common high blood pressure subtype in girls aged 6–8 years and boys aged 6–7 years. The prevalence of isolated systolic high blood pressure, isolated diastolic high blood pressure and combined systolic and diastolic high blood pressure after age and body mass index adjustment were 11.3%, 3.85, 3.0% and 7.6%, 4.0%, 2.7% for boys and girls, respectively (p < 0.005). Conclusions: Isolated systolic high blood pressure is found to be the most common high blood pressure subtype in children and it is more prevalent in boys. The distribution of high blood pressure subtypes in boys does not significantly differ from those in girls. These results may be useful for preventing and controlling pediatric hypertension.

Women’s Stated Preferences for Conditional Cash Transfer Programs Focused on Maternal and Child Health and Nutrition in India (P22-012-19)

ObjectivesConditional Cash Transfers (CCTs) are important national strategies to improve maternal and child health and nutrition. India recently began implementing a Maternity Benefit Program (MBP) to encourage health care use during pregnancy and early childhood; under discussion is to include child nutrition services within a CCT program. This paper aims to understand the preferences of mothers with young children for design features (cash transfer amount and conditionalities) of CCT programs. MethodsWe conducted a Discrete Choice Experiment in Uttar Pradesh, India where 405 mothers with children below three years of age were interviewed. Respondents were presented 18 hypothetical CCT program profiles defined by five attributes – cash transfer amount, number of ante-natal care visits, number of visits for child immunization/growth monitoring, time taken to complete a visit, and health benefit received (proxy for service quality). Conditional logit regression was used to analyze respondent choices. ResultsMothers valued the amount of cash transfer, quality of services, and quicker health center visits. They did not have a strong preference for the number of visits required. Higher cash amounts are associated with greater probability of participation. For any given amount of cash amount, better service quality (produced better health) elicited greater participation. Mothers put high valuation on service quality; they were willing-to-pay (give up) INR 2858 ($41) for a program that produced good health. Without any cash transfer, only improving service quality from average to good would increase participation by 27%. A cash transfer amount of INR 6000 ($86, currently offered by MBP) combined with fair (good) quality services would increase participation by 78% (85%). Preference for CCT programs differed across sub-groups defined by prior users of government health services and socioeconomic status. Poor households valued a given cash transfer amount more than better-off households, while better-off households valued good health outcomes more than poorer households. ConclusionsAligning maternal and child health CCT programs with user preferences can increase program participation. This study provides guidance on incorporating user preferences in the CCT program design. Funding SourcesDepartment of International Health, Johns Hopkins University.

Patient transportation in Canada's northern territories: patterns, costs and providers' perspectives.

Canada's northern territories are characterized by small, scattered populations separated by long distances. A major challenge to healthcare delivery is the reliance on costly patient transportation, especially emergency air evacuations (medevacs). The purpose of this study was to describe the patterns, costs and providers' perspectives on patient transportation, and identify potential factors associated with utilization and performance. Secondary analyses of medical travel databases and an online survey of nurses in the communities and physicians in regional centers were undertaken. The proportion of the population living within 100 km of a hospital was 83% in Yukon, 63% in Northwest Territories (NWT) and 21% in Nunavut. In Nunavut and NWT, road access to a hospital was limited to residents of the cities where the hospitals were located, with the rest relying exclusively on air travel. Medevac rates varied among the three territories: 0.9 trips/1000 residents/year in Yukon, 32/1000 in NWT and 53/1000 in Nunavut. In Yukon, all communities except one are road-accessible whereas in Nunavut no communities are connected by roads. The relative absence of roads is a major reason why the patient transportation costs are high in Nunavut and NWT. The rate of medevacs originating from the remote, air-accessible-only communities varied greatly, which cannot be explained by the air distance from the nearest hospital, population size or frequency of health center visits. Medical travel accounts for 5% of the health expenditures in NWT and 20% in Nunavut. A medevac on average costs $218 per person per year in NWT and $700 in Nunavut. The providers survey detected only 66% or less in support of statements that nurses in the communities received timely access to clinical advice, whereas only 50% of physicians agreed with statements that the clinical information provided by the nurses was clear. Patient transportation, especially emergency air evacuations, is an essential but costly component of the healthcare system serving Canada's north. It is the 'glue' that binds an extensive network of facilities staffed by different categories of health professionals. While system design is largely dictated by geography, addressing human factors such as interprofessional communication is important for improving the system's effectiveness. This study is primarily descriptive and it points to additional areas for improved understanding of the performance of the system.

The Challenges of the Malaria Elimination Program in the South East of Iran, a Qualitative Study

Despite all the efforts made to control and eliminate malaria in Iran, this disease is still considered as a priority health problem in the South East of Iran. We aimed to determine the cultural obstacles which have prevented the elimination of malaria in this region. This study was carried out through qualitative content analysis. Purposeful sampling was done from people who had malaria or were involved with malaria patients in 2015, in Sarbaz City, Sistan and Baluchestan Province, Eastern Iran. Data were collected through interviews using open questions and continued until data saturation. The most important barriers in malaria prevention was delay in visiting health centers, delay in diagnosis and treatment due to superstitious beliefs, lack of information about the disease, misdiagnosis and fake doctors. Other obstacles were lack of trust and cooperation with interventions offered by the health system, lack of proper use of the available facilities to prevent malaria and commuting in the high-risk neighbor countries. Raising awareness in people, officials and health workers about malaria and preventive health interventions as well as health risks associated with fake doctors, following up and re-examination of peripheral blood smear in suspected cases, establishing malaria control stations in border areas and specific measures to refer immigrants and people crossing the border toward malaria diagnosis stations is suggested.

Outbreak detection of influenza-like illness in Prey Veng Province, Cambodia: a community-based surveillance.

ABSTRACTOn June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and patients’ records in health facilities. The team interviewed all households in the village from May 1 to June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms, and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases, including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0 per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5–14 years followed by 0–4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable to identify this epidemic, it needs to be improved.

Adolescent pregnant women\u2019s health practices and their impact on maternal, fetal and neonatal outcomes: a mixed method study protocol

BackgroundConsidering that individuals’ health practices can affect the health of both mothers and babies, this study is designed to: (a) assess adolescent pregnant women’s health practices and their relationship with maternal, fetal, and neonatal outcomes; (b) explore the perception of adolescent pregnant women about their own health practices; and (c) recommend some strategies to improve adolescent pregnant women’s health practices during pregnancy.Methods/designThis mixed-method study with the sequential explanatory design has two phases. The first phase (quantitative phase) is a prospective study to assess the adolescent pregnant women’s health practices and its relationship with maternal, fetal, and neonatal outcomes who live in Tehran, the capital city of Iran. A cluster sampling method will be used to select 316 adolescent pregnant women who visit health centers in Tehran. The second phase is a qualitative study designed to explore the adolescent pregnant women’s perception of important aspects and factors of health practices that can affect their health outcomes. In this phase, purposive sampling and in-depth individual interviews will be conducted for data collection. The conventional content analysis approach will be employed for data analysis. In addition to literature review and nominal group technique, the findings of the qualitative and quantitative phases, will be used to recommend some strategies to support adolescent pregnant women to improve their health practices during pregnancy.DiscussionThis is the first study looking into health practices in adolescent pregnant women which will be performed via a mixed-method approach, aiming to develop health practices improvement strategies. It is worth noting that there is no strategic guideline in Iran’s health system for improvement of health practices of adolescents. Therefore, it is hoped that the strategy proposed in the current study can enhance health practices of adolescents during pregnancy and ultimately improve their pregnancy and childbirth outcomes.Ethical codeIR.TBZMED.REC.1397.670.

Development and validation of measurement tools for user experience evaluation surveys in the public primary healthcare facilities in Greece: a mixed methods study

BackgroundThe public primary healthcare system in Greece has not been fully developed and is delivered by urban and rural health centers, outpatient departments in public hospitals and the recently established first-contact and decentralized local primary care units. The aim of this study was to develop a valid and reliable measurement tool for conducting periodic user experience evaluation surveys in public Primary HealthCare facilities in Greece such as outpatient clinics of public hospitals and health centers.MethodsA mixed methods approach was applied. In particular, the methodology of developing and validating the tools included three steps: (a) establishment of the theoretical background/literature review, (b) qualitative study: development of the tools items and establishment of the face validity and (c) quantitative study: pilot testing and establishment of the structural validity and estimation of the internal consistency of the tools. Two patient focus groups participated in qualitative study: one visiting health centres and the other visiting the outpatient clinics of public hospitals. Quantitative study included 733 Primary Health Care services’ users/patients and was conducted during August–October 2017. Exploratory and confirmatory factor analysis was performed to check for structural validity of the tools, while Cronbach’s alpha coefficients were estimated to check for reliability.ResultsConfirmatory factor analysis confirmed almost perfectly the presumed theoretical model and the following six factors were identified through the tools: (a) accessibility (three items, e.g. opening hours), (b) continuity and coordination of care (three items, e.g. doctor asks for medical history), (c) comprehensiveness of care (three items, e.g. doctor provides advices for healthy life), (d) quality of medical care (four items, e.g. sufficient examination time), (e) facility (four items, e.g. comfortable waiting room) and (f) quality of care provided by nurses and other health professionals (four items, e.g. polite nurses).ConclusionsWe have developed reliable and valid tools to measure users’ experiences in public Primary HealthCare facilities in Greece. These tools could be very useful in examining differences between different types of public Primary Health Care facilities and different populations.

The Determinants of Delayed Diagnosis and Treatment Among Malaria Patients in Myanmar: A Cross-Sectional Study

Background: This cross-sectional study was conducted to assess the determining factors for delayed diagnosis and treatment among malaria patients in Myanmar. Methods: The sample comprised 220 respondents diagnosed with malaria last year, living in the upper, middle, and lower part of Myanmar. In 2017, data were collected through interviews and analyzed using percentage, mean, standard deviation, and the chi-square test. Results: The results affirmed that most of the respondents were in the working age group and of low educational level. They also had poor knowledge and perception of malaria, and more than half of the respondents visited health centers or volunteered for their first treatment of choice. Most respondents received little social support for malaria. There were significant associations between age, sex, education, marital status, occupation, and delayed diagnosis and treatment (p &lt; 0.05). Knowledge and perceptions of malaria, health-seeking behavior, and low social support on malaria services were also significantly associated with delayed malaria diagnosis and treatment (p &lt; 0.05). Conclusion: According to the findings, appropriate strengthening of cooperation and collaborations among different sectors upon diagnosis, coverage of treatment services, interventions to increase community awareness, effective communication, behavioral changes, and improved capability of the village health volunteers are evidently needed.

Referral pattern of patients coming to Mandya Institute of Medical Sciences, Mandya

Background: In the act of medical practice, referral is the transfer of a patient’s care from one physician or clinician to another. Appropriate referral is an integral part of a complete quality health care management. At present, patients can visit any level of health care irrespective of severity of their health condition and most of the burden of these patients is on tertiary centers. This study was done to describe the Referral Pattern of Patients Coming to Mandya Institute of Medical Sciences, Mandya.Methods: It was a cross sectional study conducted from October 2017 to November 2017 with sample size of 400, p=50%. Sampling technique used was convenient sampling and data was collected by interview using the semistructured questionnaire.Results: Among the study population 197 (49.3%) were males and 203 (50.7%) were females, 392 (82.3%) had BPL card. Mean distance travelled by them to MIMS was 17.7±14.8 km. Medicine department n=80 (20%) followed by ophthalmology department n=64 (16%) were the most frequently visited departments. Mean distance to the nearest health center from their place of residence was 3.2%±2.9 km. 148 (37.0%) visited the health center near their place of residence before coming to MIMS and 253 (63.0%) did not visit.Conclusions: Most of the patients visited tertiary healthcare center (MIMS) without visiting health center near to them, though the distance is more and availability of specialists and low cost of treatment were the main reasons for visiting MIMS.

9. Photovoice: Empowering Transgender And Gender-Expansive Youth

Transgender and gender-expansive youth have unique healthcare needs; however, they often eschew visiting health centers given a history of misinformation and discrimination. Photovoice, a community-based participatory research method, is an apt technique to engage this population. This study sought to learn from the unique perspectives of transgender and gender-expansive youth on what may challenge or facilitate gender identity affirmation to improve healthcare usability for those receiving care at a gender affirming clinic. We recruited 16 transgender and gender-expansive youth from a gender clinic at a children’s hospital. Eleven transmen and five transwomen (ages 16-21) participated in an initial session that discussed photography techniques, safety, and ethics. Participants were prompted to take photographs for one month to explore how their gender identity affects their social relationships including their clinical care. After one month, all participants engaged in critical reflection of their photos and an in-depth interview with a study member. Of the 16 participants, 6 also participated in a focus group. Interviews and the focus group were audio recorded, transcribed, and analyzed using Grounded Theory. Three key themes emerged: positive effects of care, gender representation, and advocacy. Participants described many ways that transition and gender affirming care had positively affected their physical, emotional, and social health: “Transitioning has been my process of finding safety and of finding affection, both within and without myself.” Participants also emphasized the importance of representations of gender and trans identity. They confronted how idealized masculine or feminine gender expression should not be an expectation: “I see it so much with the celebrities that are trans and open about it. They present so femininely and it’s a hyper-femininity that not everyone can attain or even wants to obtain.” Other participants mentioned being disregarded by peers, family, and health providers by not presenting convincingly enough or by experimenting with makeup, clothing, or other gendered activities. Some emphasized that being trans is only one part of their identity and they rebuked social relationships or healthcare services that exoticized them as trans above all else: “A really important part of my transition and my journey is [that] another person wouldn’t see me as an object or an oddity.” Lastly, participants expressed the importance of advocacy on behalf of others and recognized that they receive gender affirming care others are not able to access: “If you are in a place of privilege, it is your responsibility as someone who has power in society to stand up for the people who don’t.” Transgender youth identified many opportunities to improve the quality and accessibility of gender affirming care. Their narratives revealed that youth experience and express gender in complex ways, and experimentation should not impact a person’s ability to affirm their gender identity. To further improve gender affirming care, providers need to take this complexity into account in their provision of comprehensive health services.

Is maternal health services utilization predict the contraceptives adoption in extended postpartum period: A community-based cross-sectional study done in urban slums of Western Gujarat

Background:Family planning (FP) programme has been integrated since long with MCH programme in order to reduce maternal and child mortality. The period of pregnancy, delivery, and postnatal period is very crucial to sensitize the women to adopt contraceptive practice because during this time they are in constant contact with health provider and more receptive to advice. The present study is designed in this context to see whether the utilization of maternal health services have any impact on adoption of modern contraceptives in extended postpartum period.Materials and Methods:Community-based cross-sectional study was done in urban slum of Jamnagar, Gujarat, for 1 year in 2016. Two-stage sampling methodology was used; in first stage, 30 Anganwadi centres (AWC) was chosen by systemic random sampling and in second stage from each AWC, 8 women in extended postpartum period were included. Study included total 240 women. Sampling was done at household level. Descriptive statistics for sociodemographic factors and reproductive characteristics were done. Chi-square test was used to find association between different variables.Result:Prevalence of using modern contraceptive was only 24.6%. The most preferred choice was barrier method (35.5%), followed by sterilization (27.1%), Intrauterine device (IUD) (25.04%), and OCP (12%). Around 57% women had taken ≥4 health center visit during their last pregnancy and 7.5% had never visited or consulted. 12% women were delivered at home. Majority of the participants (63.5%) were not paid visit by health worker, only 15% were provided with adequate postnatal visit and 21% had inadequate visit during their immediate postpartum period. A statistical association was found between usage of contraceptive with health center visit during ANC, postnatal visit by HW, parity and age of women in extended postpartum period.Conclusion:There is need to improve the quality of maternal health services to increase the utilization of FP services.

Comparing the effects of training based on continuous care model and telehealth on quality of sleep in pregnant women

Background: Quality of sleep disorder is a common problem during pregnancy. Training based on continuous care model and telehealth has improved the quality of health care and may also ameliorate quality of sleep. Aim: The present study was conducted to compare the effects of training on the quality of sleep in pregnant women on the basis of continuous care model and telehealth. Method: This three-group clinical trial was performed in 2017 on 91 pregnant women visiting health centers in Mashhad, Iran. Orientation, sensitization, control and evaluation were carried out in the continuous care group, and four DVDs were watched by mothers in the telehealth group over the course of four weeks along with eight weeks of follow-up, and the routine care of health centers was administered for the control group. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed at the end of weeks 8 and 12 after the start of the study. Data were analyzed in SPSS version 24 using Kruskal-Wallis statistical test. Results: The three groups were homogeneous in terms of demographic variables (P<0.05). The Kruskal-Wallis test results showed that the mean quality of sleep score before the intervention was homogeneous among the three groups (P=0.42), but it was significantly different (P<0.001) immediately after the intervention in the three groups of continuous care (4.4±1.7), telehealth (4.4±1.4), and control (9.0±3.7), and there was a significant difference four weeks post-intervention in the three groups of continuous care (3.5±2.1), telehealth (5.3±1.8), and control (10.7±3.1) (P<0.001). Implications for Practice: Training based on the continuous care model and telehealth can improve the quality of sleep in pregnant women. Considering that telehealth is a simpler and easier method, it can be used to boost the quality of sleep in pregnant women.

Malaria, hepatitis B and HIV /AIDS, and their co-infection among Patients Visiting Health Centres in Akure, Nigeria

Co-infection is the simultaneous infection of host by multiple pathogenic species, which may co-exist together or not. In this study, the co-infection of malaria, HIV/AIDS and hepatitis B was investigated, using four different locations in Akure, Ondo State. Blood samples were aseptically collected from the left thumbs of 500 respondents using sterile lancets. Thin and thick smear of the blood samples were observed for malaria parasites using X100 magnification of the light microscope. Hepatitis B and HIV/AIDS were tested using diagnostic test kits. The results show that highest prevalence of malaria was observed in Oba-Ile (82.09%) among age group 31-40 years (92.72%). The lowest prevalence was found in Ala-Ajagbusi (73.17%) among age group 21-30 years (70.03%). Highest prevalence of hepatitis (7.06%) was observed in Orita-Obele while the lowest prevalence was observed in Ala- Ajagbusi (4.88%). HIV/AIDS infection was found Orita-Obele (1.76%, n=3) and Ala-Ajagbusi (2.44%, n=2). The results further show that all the individuals that tested positive to hepatitis B virus and HIV also tested positive to malaria. Also, 3 of the 5 individuals infected with HIV/AIDS tested positive to hepatitis B virus. Similarly, malaria, hepatitis B virus and HIV cohabit in 2 individuals; 1 in age group 21-30 years and 1 in age group 31-40 years. Coinfection of malaria with hepatitis and HIV/AIDS suggests that malaria is an opportunistic infection among the hepatitis and AIDS patients. This calls for prompt malaria treatment among the immunocompromised patients. More so, there should be adequate and consistent public health advocacy programs, to enlighten the populace about malaria, hepatitis B and HIV/AIDS in order to completely mitigate the disease spread in the area.