Joshua A. Reyer

Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two district hospitals in Savannakhet Province, Lao PDR

ABSTRACT Snakebite is a neglected condition and a common public health problem in Lao People’s Democratic Republic (Lao PDR), with a high incidence of up to 1,105 cases per 100,000 persons per year. Snakebite patients with systemic envenoming do not receive effective treatment at local health facilities. Healthcare providers have only limited knowledge in assessing and providing the correct treatment for venomous snakebites. A cross-sectional study was conducted among 119 healthcare providers in Savannakhet Province, Lao PDR, with respect to their socio-demographic characteristics, knowledge of snake identification, and management of snakebite. Data was analyzed using SPSS. Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) of adequate knowledge for treating snakebites among the healthcare providers. Among 119 participants, 27.7% and 45.4% had an adequate knowledge of snake identification and management of snakebites, respectively. Approximately 59% could correctly identify symptoms of envenomation, and 19.3% expressed confidence in treating snakebites. Study participants who had received training achieved significantly better snake identification results compared to those without training, with an OR of 2.54 (95% CI: 1.02–6.28). In particular, physicians achieved significantly better results compared to nurses in knowing how to manage snakebites, with an OR of 2.31 (95% CI: 1.04–5.12). Given the level of inadequate knowledge of snakebite management among healthcare providers in the province, more training in snakebite management is needed. University and Health Science Colleges should include snakebite management into the curriculum, to ensure that medical graduates have the appropriate knowledge and skills to treat snakebites.

Socio-economic and demographic determinants of full immunization among children of 12–23 months in Afghanistan

ABSTRACT Immunization is one of the most cost-effective interventions to reduce vaccine-preventable diseases morbidity and mortality. Vaccination coverage is very low in Afghanistan; National Risk and Vulnerability Assessment (NRVA) Survey 2008 estimated the coverage of fully immunized children to be 37%. The current study was designed to examine the factors influencing full immunization among children aged 12–23 months. Demographic and vaccination data of 2,561 children of 12–23 months was extracted from the Afghanistan Health Survey (AHS) 2012. The data was analyzed by logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). The study found that 38.8% of the children were fully immunized. The coverage for specific vaccines was 80.9% for BCG, 72.0% for OPV3, 64.8% for measles, and 50.1% for Penta3. Urban residence (AOR = 0.60, 95% CI 0.40–0.90 relative to rural), children of poorer families (AOR = 1.36, 95% CI 1.10–1.67 relative to poorest), some education (AOR = 1.59, 95% CI 1.20–2.11 relative to no education) and antenatal care (AOR = 1.70, 95% CI 1.44–2.01 relative to not received) were found to be significant predicators of full immunization. This study indicated that the full-immunization rate in Afghanistan was quite low compared to the national target of 90% coverage. Therefore, strategies taking into account the identified factors seem to be vital to improve vaccination coverage.

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR

ABSTRACT To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its “Free Maternal Health Services Policy” in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people’s education status and health care accessibility.

The Study on Patient Dissatisfaction with Medical Services to define an Indicator of the Healthcare Management in the Ton and Issyk-Kul Regional Hospitals of Kyrgyzstan

Objectives: This study aimed to define major criteria potentially influencing patient dissatisfaction, using data from two regional hospitals (RH) to identify priority areas for potential care improvement. Method: This was a cross-sectional study conducted from July to September 2014. Participants were 500 patients (230 at Ton RH and 270 at Issyk-Kul RH) selected during the designated period. Participants were surveyed with dissatisfaction measures, including 21 perceived quality-of-care indicators, divided into organizational, competency and informational aspects. We estimated associations between patient dissatisfaction and these aspects in designated hospitals using Chi-square tests. The organizational aspect included 11 criteria. Results: The long waiting period for hospitalization and untimely physicians’ rounds in Ton RH (79.1% in both characteristics) caused dissatisfaction. At Issyk-Kul RH, 78.5% of patients were dissatisfied with securing of nutrition and food quality. There was a significant difference in the criterion of timely observation by doctors between the two RH (p=0.006). Of the nine parameters of competency, significant differences were obtained at both RHs for insufficiently friendly nurse attitudes toward patients (p<0.001), and completeness of primary medical check (p=0.004). Regarding the information aspect, 68.7% of patients in Ton RH and 69.3%-in Issyk-Kul RH were dissatisfied with informational materials availability. Conclusions: Our findings suggest that clinical staff should be implemented to learn patients’ expectations and opinions about hospital services. Securing high patient satisfaction is equally important for a hospital management team. Correspondence to: Yoshitoku Yoshida, Faculty of Nursing, Shubun University, 6 Nikko-cho, Ichinomiya, 491-0938, Japan. Tel: +81-586-45-2101 (Ext: 10502); Fax: +81586454410; E-mail: yoshida.yo@shubun.ac.jp