Mohammad Afzal Mahmood

Efficiency Measurement for Hospitals Owned by the Iranian Social Security Organisation

This study used Data Envelopment Analysis (DEA) to examine the relative efficiency of hospitals owned by the Iranian Social Security Organization, which is the second largest institutional source of hospital care in that country. Using data for the year 2002, 26 of the 53 hospitals were deemed to be efficient. Inefficient hospitals had an average score of 90%, implying a potential reduction in all inputs on average by about 10% with no impact on output levels. In addition to the conventional DEA measurement, efficient hospitals were ranked by calculating super-efficiency scores, by identifying weak efficient hospitals, and by determining the frequency of peers. The study provides useful information for improving hospital management, rationalizing resource allocation, and improving services provided by hospitals.

Is There Any Association between Use of Smokeless Tobacco Products and Coronary Heart Disease in Bangladesh

Background Most epidemiological studies exploring the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) have been in Western populations, and have focused on SLT products used in those countries. Few studies come from South Asian countries. Our objective was to determine the association between SLT use and CHD among non-smoking adults in Bangladesh. Methods A matched case-control study of non-smoking Bangladeshi adults aged 40–75 years was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Community controls, matched to CHD cases, were selected from neighbourhoods, and hospital controls were selected from outpatient departments of the same hospitals. The Rose Angina Questionnaire (RAQ) was also used to re-classify cases and controls. Results The study enrolled 302 cases, 1,208 community controls and 302 hospital controls. Current use was higher among community controls (38%) compared to cases (33%) and hospital controls (32%). Current use of SLT was not significantly associated with an increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63–1.19), or when hospital controls were used (adjusted OR 1.00, 95% CI 0.63–1.60), or when both control groups were combined (adjusted OR 1.00, 95% CI 0.74–1.34). Risk of CHD did not increase with use of individual types except gul, frequency, duration, past use of SLT products, or using the RAQ to re-classify cases and controls. There was a significant association between gul use and CHD when both controls were combined (adjusted OR 2.93, 95% CI 1.28–6.70). Conclusions There was no statistically significant association between SLT use in general and CHD among non-smoking adults in Bangladesh. Further research on the association between gul use and CHD in Bangladesh along with SLT use and CHD in other parts of the subcontinent will guide public health policy and interventions that focus on SLT-related diseases.

Separation from family and its impact on the mental health of Sudanese refugees in Australia: a qualitative study

Objective : This study explored the impact of separation from family members on the mental health and wellbeing of Sudanese refugees in Australia, and the coping strategies used.

Musculoskeletal pain and discomfort and associated worker and organizational factors: a cross-sectional study.

BACKGROUND Musculoskeletal disorders are a leading cause of work-related ill health, and a major cost burden for the individual, industry and the community. Despite the broad range of risk factors that have been identified, most studies have focused only on specific occupations or categories of risk factors, meaning that there is limited understanding of the relative contributions of individual and organisational, physical and psychosocial factors. OBJECTIVE This cross-sectional survey of workers in medium-to-large workplaces in South Australia sought to examine a broad range of factors within various workplaces and industries. PARTICIPANTS 404 workers from 29 workgroups and 23 separate companies participated in the research. METHODS Questionnaires were administered face-to-face, assessing demographic and job characteristics, safety climate, musculoskeletal pain and discomfort (MSPD) and job satisfaction. Potential predictors were grouped in terms of personal/job and organizational characteristics and associations with MSPD examined. RESULTS A considerable proportion of workers (40%) had experienced MSPD in the last 7 days and 15% had experienced severe MSPD. In a multivariate model, four variables were found to be significantly associated with MSPD, namely being aged > or =40 years (adjusted odds ratio=1.73), overall job satisfaction (negatively associated) (AOR=0.37), medium (vs. large) company size (AOR=1.80) and workgroup safety climate score (negatively associated) (AOR=0.58). CONCLUSIONS The results confirm a link between non-physical factors and work-related musculoskeletal disorders, suggesting that these factors should received increased attention as part of overall health and safety strategies. Organizations should give greater consideration to both the satisfaction of their employees and organizational factors that set the tone for safety climate.

Measuring Antenatal Depression and Anxiety: Findings from a Community-Based Study of Women in Hyderabad, Pakistan

ABSTRACT This study evaluated the psychometric properties of two possible measures of depression and anxiety among pregnant women in Pakistan for use in the Global Network for Womens and Childrens Health Research project, a collaborative, international multi-site research network investigating methods for improving pregnancy and birth outcomes in developing countries. The first measure, the Aga Khan University Anxiety and Depression Scale (AKUADS), is an Urdu language scale originally developed for the general Pakistani population, whereas the second measure, the How I Feel scale, was designed for pregnant women in the United States. In an earlier pilot study, we found that the two scales demonstrated similar levels of diagnostic validity. Because neither scale was designed for the specific population of interest, item response theory analyses were conducted to evaluate the psychometric properties of the scales at three levels of measurement: scale, item, and response option. The study results provide insights that may be useful to researchers or clinicians developing or using scales in this population. In particular, our findings suggest that scales designed for populations with lower literacy, such as our target population, may improve data quality by including no more than three response options (e.g., almost always, sometimes, and never) and keeping the direction of item wording consistent throughout the scale. Based on the results from the current study, we recommend a short form of the AKUADS which removes poorly functioning items and reduces respondent burden while retaining the reliability and validity of the longer form.

Why do Bangladeshi people use smokeless tobacco products

Despite scientific evidence about the harmful effects of smokeless tobacco (SLT), it is widely used in Bangladesh. This study explored perceptions about health effects of SLT use. Semistructured interviews were conducted with 1812 nonsmoking adults. About 40% of the participants were current SLT users or had used SLT in the past. Family members’ influence was the main factor for initiation. The participants believed that people continued using SLT because of addiction (52%) and as a part of their lifestyle (23%). The majority of participants (77%) did not mention any benefit, but SLT users considered it to be a remedy for toothache (P < .05). Almost all participants mentioned that SLT was harmful and causes heart disease, cancer, and tuberculosis. Doctors’ advice was the common motivating factor to quit. Health promotion interventions should highlight the adverse effects of SLT use, which outweigh the perceived benefits, and should consider addressing the role of family in SLT initiation and use.

A conceptual framework for selecting the most appropriate variables for measuring hospital efficiency with a focus on Iranian public hospitals.

Over the past few decades, there has been an increasing interest in the measurement of hospital efficiency in developing countries and in Iran. While the choice of measurement methods in hospital efficiency assessment has been widely argued in the literature, few authors have offered a framework to specify variables that reflect different hospital functions, the quality of the process of care and the effectiveness of hospital services. However, without the knowledge of hospital objectives and all relevant functions, efficiency studies run the risk of making biased comparisons, particularly against hospitals that provide higher quality services requiring the use of more resources. Undertaking an in-depth investigation regarding the multi-product nature of hospitals, various hospital functions and the values of various stakeholders (patient, staff and community) with a focus on the Iranian public hospitals, this study has proposed a conceptual framework to select the most appropriate variables for measuring hospital efficiency using frontier-based techniques. This paper contributes to hospital efficiency studies by proposing a conceptual framework and incorporating a broader set of variables in Iran. This can enhance the validity of hospital efficiency studies using frontier-based methods in developing countries.

Factors determining quality of care in family planning services in Africa: A systematic review of mixed evidence

Background Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. Methods Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. Results From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client’s waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as ‘pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers’ behaviour. Conclusion There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.

Public health and health services development in postconflict communities: a case study of a safe motherhood project in East Timor.

Armed conflict causes suffering in many countries; it contributes to poor health and hinders health services development. The effects of conflict are evidenced by weakened community structures and can make reconstruction efforts challenging. East Timor has a history of prolonged conflict and saw a resurgence of internal violence in 2006. This participant observation study discusses considerations for implementing public health and health systems development projects in postconflict settings using a case study of a maternal and child health project. It illustrates the importance of appreciating the historical context and community dynamics when implementing development projects. The sequelae of conflict are often characterized by reduced human resource development capacity, distrust of hierarchy, and limited capacity for resource mobilization. Working in such postconflict communities requires flexibility in program design, stronger efforts for community capacity building, and rebuilding trust between various stakeholders.

‘We don’t have to go and see a special person to solve this problem’: Trauma, mental health beliefs and processes for addressing ‘mental health issues’ among Sudanese refugees in Australia:

Background: The impact of trauma on refugee mental health has been a particular focal point for research and treatment in Western contexts, despite uncertainty about the degree to which this corresponds with refugees’ needs, mental health beliefs and healing mechanisms. Aims: This study explored the mental health beliefs of resettling Sudanese refugees in Australia. Methods: In-depth qualitative interviews were conducted with Sudanese community representatives and with a range of health and social work professionals who were not necessarily Sudanese. Results: The concept of trauma was not universally considered to be salient for Sudanese refugees. Key informants, especially those in refugee-oriented services, emphasised stoicism and a desire to move forward and questioned the appropriateness of Western psychological therapies. Processes that exist within the family and the Sudanese community to deal with stressors like loss, grief and social isolation were explained. Conclusion: Dialogue between services and community members is needed to ensure responses to refugee mental health are sensitive to the diversity of needs and mental health beliefs of refugees. This will enable workers to ascertain how individual refugees understand their experiences of distress or sadness and to determine whether community strategies and/or professional responses are appropriate.