Chushi Kuroiwa

Assessment of doctors' knowledge regarding tuberculosis management in Lucknow, India: A public-private sector comparison

OBJECTIVE India tops the list of 22 high-burden tuberculosis (TB) countries. India adopted directly observed treatment - short course (DOTS) under the Revised National Tuberculosis Control Programme (RNTCP) in 1992 and public-private mix DOTS in 2002. This study was conducted to assess the knowledge of doctors in the public and private sectors regarding TB control and management. STUDY DESIGN Cross-sectional study. METHODS This study used a self-reported questionnaire based on the RNTCP technical and operational guidelines. One hundred and forty-one doctors were recruited through census sampling; all were registered with the Chest Physicians Association and treating TB using allopathic medicine. The list of doctors was obtained from Lucknow District TB Office, which annually updates and manages the members list of the Chest Physicians Association. This study was conducted in Lucknow, India in February-March 2007. RESULTS Of 141 doctors, 71% had specialized medical education for treating TB, 60% had received RNTCP training and 69% reported that they follow DOTS methodology for TB treatment. Fifty-six percent of doctors worked in the public sector and 44% worked in the private sector. Forty-nine percent of doctors working in the public sector and 53% working in the private sector correctly reported all TB symptoms as per the RNTCP guidelines. Sixty-six percent of doctors in the public sector and 39% in the private sector reported the correct technique for sputum sampling. Public sector doctors demonstrated better knowledge of drug regimens for sputum smear-positive and sputum smear-negative TB than private sector doctors. Statistical analysis indicated that doctors in the public sector had 2.1 times better knowledge than private sector doctors (odds ratio 2.1; P=0.05). CONCLUSION Health policy managers and DOTS implementers should encourage all doctors, particularly private sector doctors, to receive RNTCP training and follow DOTS methodology. Improvement is needed in RNTCP training, and emphasis needs to be given to correct diagnosis, management and follow-up of TB patients.

Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale

INTRODUCTION Pakistans 2005 earthquake claimed almost 87,000 lives and displaced millions. The present study sought to assess PTSD prevalence among earthquake survivors, to evaluate its determinants, and to identify protective factors that suggest future interventions in the aftermath of disasters. METHODS In a cross-sectional survey, three districts were selected based on their proximity to the epicenter and the presence, accessibility, and security of refugees, 300 earthquake survivors were enrolled. RESULTS Analysis revealed that after 30months, PTSD prevalence was high. Being female, older, unmarried, head of the family, and currently unemployed and having low income and living in temporary housing confer higher risks of PTSD. Having a high social capital and religious inclination seem to have protective, buffer effect and increase resilience against PTSD. CONCLUSION This is the first post-quake study in Pakistan that has utilized, adapted and validated Davidson Trauma Scale in the local context. Results imply the significance of continued psychological support, of drawing on resilience factors in PTSD management. Implications and directions for future research are discussed.

Risk factors for protein–energy malnutrition in children under 5 years: Study from Luangprabang province, Laos

Background: Laos is one of the poorest countries in which chronic malnutrition is highest. The aim of the present study was to determine the prevalence of and to identify risk factors associated with protein–energy malnutrition (PEM) in children under 5 years of age in Luangprabang province, Laos.

Emergency obstetric care in Pakistan: Potential for reduced maternal mortality through improved basic EmOC facilities, services, and access

Objective: To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistans Punjab and Northwest Frontier Province (NWFP) provinces. Method: Cross‐sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n = 19); were randomly selected; all public health facilities providing EmOC services (n = 170) were included. Results: The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab. Conclusion: Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.

Predictors of Exclusive Breast-Feeding in Early Infancy: A Survey Report from Phnom Penh, Cambodia

BACKGROUND Exclusive breast-feeding (EBF) is recommended in the first 6 months of an infants life. This study aims to investigate the present status of infant feeding practices and identify factors that affect EBF practices during the first 6 months following infant birth in Phnom Penh, Cambodia. METHODS A cross-sectional survey with a semistructured questionnaire was given to 312 mothers with children aged 6 to 24 months who visited the immunization clinic in the National Maternal and Child Health Centre in Phnom Penh, Cambodia, from December 2005 to February 2006. RESULTS Eighty-three percent of mothers fed breast milk exclusively in the first month, whereas only 51.3% continued EBF in the first 6 months. Within 30 minutes after delivery, 39% of mothers began breast-feeding. Results from logistic regression analysis indicate that the lack of a maternal antenatal EBF plan (odds ratio [OR] = 10.01, 95% confidence interval [CI] = 3.68-27.24, p < .001), working mothers (OR = 4.71, 95% CI = 2.77-8.01, p < .001), and lack of paternal attendance at breast-feeding classes (OR = 1.93, 95% CI = 1.13-3.28, p < .05) have independently positive associations with cessation of EBF during the first 6 months of infant life. CONCLUSION The findings have helped to identify some important factors affecting EBF practices in the study area in Cambodia. The findings revealed that it is important to educate pregnant mothers, probably through exposure to trained midwives and media, so they may recognize the significance of EBF and will develop intention and plan to feed their babies, keeping in mind the benefits it may yield. Paternal involvement in breast-feeding classes may increase their awareness and consequently complement EBF practices. Finally, development of conducive working environments and policies for working mothers should be carefully explored because it could have positive influence in better care and promotion of EBF.

Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia

BackgroundNeedlestick and sharps injuries (NSSIs) are one of the major risk factors for blood-borne infections at healthcare facilities. This study examines the current situation of NSSIs among health care workers at public tertiary hospitals in an urban community in Mongolia and explores strategies for the prevention of these injuries.FindingsA survey of 621 health care workers was undertaken in two public tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-structured and self-administered questionnaire was distributed to study injection practices and the occurrence of NSSIs. A multiple logistic regression analysis was performed to investigate factors associated with experiencing NSSIs. Among the 435 healthcare workers who returned a completed questionnaire, the incidence of NSSIs during the previous 3 months was 38.4%. Health care workers were more likely to report NSSIs if they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95% confidence interval, CI: 1.31-4.66) and administered more than 10 injections per day (OR: 4.76; 95% CI: 1.97-11.49). The likelihood of self-reporting NSSIs significantly decreased if health care workers adhered to universal precautions (OR: 0.34; 95% CI: 0.17-0.68).ConclusionsNSSIs are a common public health problem at public tertiary hospitals in Mongolia. The promotion of adequate working conditions, elimination of excessive injection use, and adherence to universal precautions will be important for the future control of potential infections with blood-borne pathogens due to occupational exposures to sharps in this setting.

Health-care waste management in Lao PDR: a case study

This study investigated the health-care waste (HCW) management at each health-care facility level at two selected sites in the Lao People’s Democratic Republic (Lao PDR): Vientiane Municipality; and Bolikhamxay province. It focused on the amount of HCW, its segregation and the factors influencing HCW management, particularly segregation procedures. A high proportion of incorrectly segregated medical waste was found at each level of health-care facility. Re-segregation revealed 39, 62, 57 and 37% at national hospital, provincial hospital, district hospital and health centre level, respectively, was poorly segregated. The mean of generated HCW was 0.62 kg/bed per day (Vientiane Municipality) and 0.38 kg/bed per day (Bolikhamxay) at two study sites. A higher proportion of medical waste (MW) from the inpatient department at the primary health-care level was found. Thus, HCW management at primary health-care facilities needs more attention and should be better understood.

Non-polio enterovirus isolation among families in Ulaanbaatar and Tov province, Mongolia: prevalence, intrafamilial spread, and risk factors for infection.

Studies of non-polio enterovirus prevalence and transmissibility in developing countries are limited and few studies have investigated specific risk factors for infection. An epidemiological survey of non-polio enterovirus among families in Mongolia was conducted in the late summer of 2003. Stools of 122 healthy persons were collected weekly for 5 weeks. Eight serotypes of non-polio enteroviruses (echovirus 30, 33, 12, 25, coxsackievirus A10, A2, A4, A24) were isolated from 62 persons, with an overall isolation rate of 51%, and 64% and 35% among children under 10 years and adults over age 21 years. Fifty-four per cent of isolations were due to intrafamilial infection. Analysis of risk factors for infection suggested contamination of indoor kitchen, bathroom, toilet, and waste disposal area. Hand washing after defecation was protective against infection. Our study findings stress the importance of hand washing and cleaning hygienic facilities to prevent infection by enteric viruses in the home environment.

Hospital medical waste management in Shandong Province, China.

Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed— 1 day—1 in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.

Factors influencing breastfeeding in children less than 2 years of age in Lao PDR.

Aim:  This study aimed to investigate the prevalence of, and factors influencing, exclusive breastfeeding (EBF) at 6 months and continued breastfeeding (CBF) at 2 years.