Rafiqul Islam Chowdhury

Factors influencing patient satisfaction in primary healthcare clinics in Kuwait.

PURPOSE To measure the quality of health care services patient satisfaction is used as one of the most important indicators. The study aims to identify factors affecting patients satisfaction at primary health care clinics. DESIGN/METHODOLOGY/APPROACH The data was collected during January 2007 and May 2007 through a randomly-distributed questionnaire. The questionnaires were distributed in primary healthcare clinics that represent all heath care regions in Kuwait. A total of 426 completed questionnaires, out of 500, were returned resulting in a response rate of 85.2 percent. FINDINGS The majority (87 percent) of the patients responded that the time for communication between physician and patient was not enough. Seventy-nine-percent of the surveyed patients said they would go to the emergency room of the hospital in future if needed instead of going to the primary care clinic. Regarding the quality of the communication relationship between physician and patients most of the patients responded negatively. Exploratory factor analysis identified six factors and reliability of overall scale was found to be 0.61. RESEARCH LIMITATIONS/IMPLICATIONS One limitation to this study was the exclusion of the private sector. ORIGINALITY/VALUE The authors hope that this study identifies areas of dissatisfaction that can be quickly remedied and ensures enhancement in the areas of satisfaction with ongoing attention and emphasis.

Complications During Pregnancy, Delivery, and Postnatal Stages and Place of Delivery in Rural Bangladesh

The utilization of safe motherhood services including maternity care in Bangladesh is very poor. Only a very small proportion of deliveries takes place in a hospital/clinic. This study is based on data from a follow-up study on maternal morbidity in rural Bangladesh. Analysis is performed on the nature of complications by place of delivery. Most of the deliveries have taken place in the womens own or her mothers home. In addition, home deliveries are mostly assisted either by an untrained birth attendant or by relatives or others. Education, economic status, whether pregnancy was wanted or not, regular visits for antenatal care, past history of breathing problems and liver diseases, and palpitation during pregnancy appear to have significant association with place of delivery in rural Bangladesh. The utilization of a hospital/clinic instead of birth at home is higher among women with secondary or higher level of education, who desired the pregnancy, and who made regular visits for antenatal care. Delivery at a mothers home appears to be positively associated with higher economic status, desired pregnancy, gainful employment, and visits for antenatal care. If the respondents suffer from diseases/symptoms, then it is more likely that the delivery would take place in the mothers home.

Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait : a comparison between Arabs and South Asians

The objectives of this study were to describe and compare the clinical characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) in Middle East Arab (MEA) and South Asian (SA) patients diagnosed in our unit. Fifty-eight consecutive patients diagnosed with SpA were studied after classifying them into MEA and SA. They were further classified as per disease diagnosis. Excluding three patients with miscellaneous ethnicity, there were 29 MEA and 26 SA patients. Seventy-two percent of MEA patients were males (vs 92% of SA patients). Of the 29 patients with MEA ethnicity, 17 had AS and 9 had USpA. Of the 26 patients with SA ethnicity, 10 had AS and 14 had USpA. Fifty-nine percent of MEA patients had AS (vs 39% of SA patients). Mean age at onset in AS patients was similar in the two ethnic groups. However, in patients with USpA, mean age at onset was somewhat lower at 21.8 years in the MEA group compared with 29.4 years in the SA group. Family history in first-degree relatives was significantly more common in MEA patients. Weight loss, inflammatory spinal pain, gluteal pain, and enthesopathy were equally common in both ethnic groups. Knee, ankle, and metatarsophalangeal joint involvement was less common in MEA patients. There were no significant differences in the occurrence of syndesmophytes, bamboo spine, and sacroiliitis in the two ethnic groups. HLA-B27 positivity rates in MEA patients were 87% for AS and 67% for USpA compared to 75 and 71%, respectively, in SA patients. It is concluded that some significant new findings have arisen from this study: the majority of MEA patients presented with AS, whereas the majority of SA patients had a picture of USpA. Family history was more common in MEA patients. Peripheral arthritis was less common in MEA patients. Worldwide, this is the first study to show that there are significant differences in the clinical expression of the various SpA in MEA patients compared to SA patients.

The differentials and determinants of perinatal mortality in rural Bangladesh.

Objective: In Bangladesh, the perinatal mortality is very high. This study examined the differentials and determinants of perinatal mortality in rural Bangladesh. Methods: The study was based on the prospective data on maternal morbidity collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). This prospective study was conducted during the period November 1992 to December 1993. In this study, the factors associated with perinatal deaths were examined, employing differential and multivariate analyses. Results: It was found that assisted delivery caused higher risks of stillbirth and death among live births during the first week of life. It was also observed that five or more pregnancies, prior to the index pregnancy, were positively associated with perinatal death. Conclusion: If the delivery is assisted or there are complications in delivery, then it is likely that the incidence of perinatal mortality will increase sharply. If the newborn baby was given colostrum, then perinatal mortality decreased to a great extent.

Frequency of Red Blood Cell Alloantibody in Kuwaiti Population

Objective: The aim of this study was to analyze the alloimmunization against red blood cells (RBC) among Kuwaiti population. Materials and Methods: Retrospective analysis of RBC alloimmunization among 179,045 Kuwaiti patients, pregnant women, and allogeneic blood donors was conducted for the period of 1992–2001. The frequency of 24 alloantibody specificities from 1,278 alloimmunized Kuwaitis was estimated. Results: The prevalence of positive antibody screen in Kuwait was 0.49%.The five most frequently identified alloantibodies were anti-D (27.3%), anti-E (18.5%), anti-K (15.6%), anti-Lea (8.7%), and anti-Leb (6.6%). Frequency of alloimmunization was greater among Kuwaiti female than male patients (3.2 F to 1 M). Anti-D (p < 0.001), anti-E (p = 0.05), anti-K (p = 0.04) were also more frequently identified alloantibody among Kuwaiti females. Conclusion: The results show higher predominance of RBC alloimmunization in females than males. Anti-D, anti-E, and anti-K were the most common clinically significant alloantibodies identified in the Kuwaiti population and were also more frequent among Kuwaiti females.

Reasons and correlates of contraceptive discontinuation in Kuwait

Objectives (1) To examine the probability of discontinuation of various methods within 1, 2, and three years of use and the reasons for discontinuation; 2) to analyse the socio-demographic correlates of discontinuation. Methods Data from a survey of Kuwaiti women in reproductive ages conducted in 1999 were used. Information on duration of use of modern and traditional methods, and reasons for discontinuation during the 72 months before the survey were analysed. Probabilities of discontinuation were estimated through multiple decrement life table analysis. Results After 1 year, 30% of modern and 40% of traditional method users had discontinued; after 3 years, discontinuation increased to 66 and 70%, respectively. After 36 months, only 40% of IUD users discontinued compared with 74% of oral contraceptive users. The desire to become pregnant was the leading reason for discontinuation of most modern methods, while method failure was an equally important reason for traditional methods. Discontinuation was significantly more frequent among higher parity, non-working and Bedouin women, and among those who said Islam disapproves of contraception. Discussion Contraception is used largely for spacing. More than two-thirds of the women studied had discontinued most methods after three years, except the IUD, which was used only by about 10% of them. Traditional methods are often discontinued due to method failure and may result in an unintended pregnancy. Better counselling is warranted for traditional methods. Health care for managing side effects of modern methods also needs improvement.

Factors associated with delivery complications in rural Bangladesh

Objectives There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. Methods A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. Results and conclusions It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.

Correlates of Job Satisfaction among Health Care Professionals in Kuwait

Objectives: Job satisfaction of health care providers (physicians, nurses, pharmacists, and medical laboratory technologists) was analyzed in relation to specific background and work environment characteristics in a multicultural setting. Methods: A stratified random sample was used to collect the data from six general hospitals in Kuwait. Data were collected through a self-administered questionnaire distributed to 500 health care providers, of whom 370 (74%) responded. Results: In bivariate analysis, nationality, education, age, and total experience were found to be significant determinants of job satisfaction. However, in multivariate analysis, three work environment characteristics emerged as significant determinants of job satisfaction. The nationality of the supervisor and in-service training showed a positive relationship with job satisfaction while the existence of unhealthy competition decreased job satisfaction. Conclusions: In view of the findings, employee job satisfaction can be improved through control of unhealthy competition, provision of an orientation to the job, and provision of effective in-service training.

Patient demographics and disease variables correlate with distinct cytokine patterns in mitogen-stimulated peripheral blood mononuclear cells from rheumatoid arthritis patients

There is paucity of literature on the association of peripheral blood cytokine patterns with patient demographics and disease variables in rheumatoid arthritis (RA). We test the hypothesis that there may be differences in peripheral blood levels of inflammatory cytokines in RA subjects according to various disease variables. In this case, we could identify peripheral blood cytokine markers that correlate with different disease variables. Forty-two seropositive RA patients were characterized according to the age at onset, gender, disease duration, severity, activity and ACR functional class. The production levels in mitogen-stimulated PBMCs of five pro-inflammatory cytokines (IFNγ, TNFα, TNFβ, IL-8, IL-18) and three anti-inflammatory cytokines (IL-4, IL-10, IL-13) were evaluated in these patients and in healthy controls. Several new findings emerge: (1) higher levels of IL-4 correlate with female gender, milder disease, non-erosive disease, and earlier age at onset; (2) higher levels of IL-10 correlate with the requirement of ≤2 DMARDs; (3) higher levels of IL-18 correlate with non-erosive disease and younger age at onset; (4) higher TNFβ levels correlate with older present age of patients; and (5) higher IL-8 levels correlate with established/late disease. There are several interesting differences in cytokine patterns with respect to age at onset, current age, disease severity, and the number of DMARDs the patients require.

A profile of contraceptive non-use in Kuwait: implications for health and health care

Objectives: To analyze the characteristics of women who have never used contraception, and do not intend to use it in the future; examine the factors affecting such behavior and intentions; and discuss their health implications. Methods: Survey data from a nationally representative random sample of Kuwaiti households, collected in a study conducted in 1999 and containing 1502 currently married women, were analyzed using logistic regression analysis. Results: Based on the present study, 19% of women had never used contraception and 50% were not using contraception when interviewed. Among current non-users, 42% did not intend to use contraception, and 31% were unsure about use during the following year. Negative attitudes of the respondents and their husbands were the critical factors in non-use and future intentions for non-use. Never-users were older (average age 37.8 years) and of higher parity (6.2) than other women. Conclusion: Being older and of higher parity, never-users constitute a high-risk group that may be in need of counseling. Also, negative attitudes towards contraception need modification.