Bojana Matejic

Maternal satisfaction with organized perinatal care in Serbian public hospitals

BackgroundUnderstanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia.MethodsOur survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors.ResultsWe analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care.ConclusionsOur study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and satisfaction with perinatal care in Serbian public hospitals by women.

Do we have primary health care reform? The story of the Republic of Serbia

OBJECTIVE To provide insight of national activities and international assistance in PHC reform and to assess their effects on technical and allocative efficiency as well as financial sustainability of primary health care in the Republic of Serbia. MATERIALS AND METHODS Analytical framework of the study consisted of gathering and reviewing of relevant political documents, international assistance project documentation, and analysis of routinely collected national statistical data based on the evaluation model of three groups of criteria: allocative, technical efficiency and financial sustainability in the public sector of Serbia from 2000 to 2007. Time trends were analyzed by Poisson regression models using average annual percentage changes--AAPC, and the percent of targeted change achieved by progress quotient--PQ. RESULTS Allocative efficiency of the PHC during period of 8 years was improved, but technical efficiency was almost unchanged for all service, except for preschool health care. Financial sustainability was also improved measured by indirect indicators of health expenditure. CONCLUSIONS Results of this study indicated that we are on the right track with PHC reform, and international support is in accordance with the reform goals. Our approach has been and will remain incremental, gradualist and multi-faceted.

Communications about cervical cancer between women and gynecologists in Serbia

SummaryObjective:The age-standardized incidence rate of cervical cancer in Serbia is 27.2 per 100,000 women, i. e., twice as high as in western European countries. This paper explores the communication which occurs between women and gynecologists in Serbia in relation to cervical cancer screening.Methods:Our study was conducted in two phases: a qualitative phase (focus group discussions and in-depth interviews with women) and a quantitative phase (community-based survey). This paper reports the findings from both phases, and in particular, the in-depth interviews with 22 women with different socio-economic backgrounds residing in the capital city and a regional town. To illustrate women’s experiences and attitudes, we used interview excerpts.Results:Our findings indicate that there is poor communication between women and gynecologists and an absence of proper counseling. Women’s lack of knowledge about reproductive health issues, poor attitudes of gynecologists, and personal barriers that women experience in accessing health care render preventive practices a low priority both for women and gynecologists.Conclusion:We recommend different educational and organizational strategies that may improve the counseling skills of gynecologists and ultimately reduce the prevalence of cervical cancer in Serbia.

Trends and patterns of ovarian cancer mortality in Belgrade, Serbia: a joinpoint regression analysis.

Objective: Ovarian cancer (OC) represents the leading cause of gynecological cancer deaths. The aim of our study was to estimate the patterns and trends in OC mortality in the population of Belgrade (Serbia) during the period 1976 to 2007. Methods: Mortality data (official death certificates) for OC have been gathered from the Municipal Institute of Statistics in Belgrade. Mortality rates with corresponding 95% confidence intervals were adjusted by the European standard population. Trends in age-adjusted and age-specific mortality rates were calculated using joinpoint regression, according to the method of Kim et al. An annual percent of changes in mortality rates for each line segment was estimated by fitting a regression line to the natural logarithm of the rates using calendar years as a regressor variable. Results: The average age-adjusted OC mortality rate during the period 1976-2007 was 5.4/100,000 (95% confidence interval, 4.8-6.1). For total women population, no joinpoint is found, whereas significantly increasing mortality trend was observed during the whole study period (+3.6% annually; P < 0.001). In the group age 55 to 64 years, one joinpoint was detected with a significant increase in OC mortality trend between 1976 and 1990 (+9.8% annually; P < 0.001) and with nonsignificant decreasing tendency between 1990 and 2007 (−1.0% annually; P = 0.773). In the two oldest age groups, statistically significantly increasing tendency in OC mortality was evident during the overall calendar period with no apparent change in linear trends. Conclusions: Mortality due to the OC in Belgrade has continued to increase, suggesting that this malignancy is becoming an increasing public health problem in our country.

Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals

We report findings from a validation study of the translated and culturally adapted Serbian version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS), for a sample of anesthesiologists working in the tertiary healthcare. The results showed the sufficient overall reliability (Cronbachs α = 0.72) of the scores (items 1–22). The results of Bartletts test of sphericity (χ 2 = 1983.75, df = 231, p < 0.001) and Kaiser-Meyer-Olkin measure of sampling adequacy (0.866) provided solid justification for factor analysis. In order to increase sensitivity of this questionnaire, we performed unfitted factor analysis model (eigenvalue greater than 1) which enabled us to extract the most suitable factor structure for our study instrument. The exploratory factor analysis model revealed five factors with eigenvalues greater than 1.0, explaining 62.0% of cumulative variance. Velicers MAP test has supported five-factor model with the smallest average squared correlation of 0,184. This study indicated that Serbian version of the MBI-HSS is a reliable and valid instrument to measure burnout among a population of anesthesiologists. Results confirmed strong psychometric characteristics of the study instrument, with recommendations for interpretation of two new factors that may be unique to the Serbian version of the MBI-HSS.

‘The Devil has entered you’: A qualitative study of Men Who Have Sex With Men (MSM) and the stigma and discrimination they experience from healthcare professionals and the general community in Bosnia and Herzegovina

Men who have sex with men (MSM) are often exposed to unequal treatment in societies worldwide as well as to various forms of stigma and discrimination in healthcare services. Bosnia and Herzegovina (B&H) is a postconflict developing country located in Southeast Europe and the Western Balkans, where little is known about the experiences of MSM regarding their communities and interactions with healthcare services. The aim of this study was to explore the types of experiences MSM face and to assess the level of stigma and discrimination they are exposed to in this setting. We conducted twelve in-depth face-to-face interviews with MSM who were 16 to 45 years old and residing in B&H. The main findings indicated that they all experienced various levels of stigma, discrimination, prejudice and inequities in treatment and attitudes from different segments of society, including the health care sector, that prevented them from fully developing their human and health potential. Additionally, these experiences were adversely related to opportunities to receive good quality health care services due to the insufficiently educated and old-fashioned health professionals who sometimes believed in black magic practices. The findings present numerous opportunities for educational trainings and structural reform to create a society that provides and guarantees equal opportunities for all.

Development of a risk index for prediction of abnormal pap test results in Serbia.

BACKGROUND Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. MATERIALS AND METHODS The study population was drawn from patients attending Departments for Womens Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. RESULTS Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most respondents had a score 0 (54.9%). In the index-creation dataset mean index score was 10.3 (SD-13.8), and in the validation dataset the mean was 9.1 (SD=13.2). CONCLUSIONS The advantage of such scoring system is that it is simple, consisting of only four elements, so it could be applied to identify women with high risk for cervical cancer that would be referred for further examination.