Our study has some limitations. First, diagnoses dur- ing the current pregnancy were recorded from open questions (e.g. vaginal bleeding near full term), and may have been reported differently among hospitals. Some misclassifications probably occurred by categorizing some exposed women (i.e. who had a condition) as non- exposed. If differential according to the mode of delivery, these misclassifications may have overestimated the level of association of corresponding individual factors. Sec- ond, the standardized inventory we used to assess avail- able resources was not defined to assess 24h/day availability and real utilization of all the resources . Some misclassifications probably occurred by categoriz- ing some exposed hospitals (resource available but not used) as non-exposed, leading to possible underestima- tion of the corresponding Odds ratios. Thirdly, a large part of the between-hospital variability (45%) remained unexplained for intrapartum CS. This heterogeneity may be due to financial and medical practitioner factors that were not measured in our study. Financial barriers may be still present in some hospitals where the policy has not been fully implemented . Younger physicians working alone in remote areas may have different prac- tices than older physicians working in cities [9,26]. Tak- ing this information into account would improve the performance of our predictive model, but would not affect the results dramatically.
human immunodeficiency virus (HIV), chronic pulmon- ary, cardiac or renal diseases, sickle cell trait or chronic hypertension; prepartum severe anemia (<7 g/dL); gesta- tional hypertensive disorders including the following diag- noses: gestational hypertension, pre-eclamspia, eclampsia, hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome ; referral from another health facility; induction of labor; prolonged labor, including the follow- ing diagnoses: obstructed labor, cephalopelvic dispropor- tion, dystocia, labor not progressing according to a normal partogram; mode of delivery categorized as: spontaneous vaginal delivery, C-section before the onset of labor, C-section after the onset of labor, forceps/vac- uum extraction; and birth weight categorized as: <2500, 2500–4000, >4000 grs.
This is a cross-sectional analysis of pre-intervention data from the QUARITE (quality of care, risk management and technology in obstetrics) trial, a cluster-randomized multicenter intervention study conducted in Mali and Senegal . The QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658. Data collection on all births in the study period took place at 46 public referralhospitals (district, regional, and national/teaching hospitals). For more details on the trial protocol and principal results see Dumont et al., 2009 and Dumont et al., 2013 [18, 19]. The sample includes all women (N = 84,924) that delivered at any of the 46 referralhospitals during the pre-intervention period (Oct. 1, 2007 – Oct. 1, 2008) of the trial. The data collection system was based on the World Health Organization (WHO) global health survey of maternal and perinatal health, which included collec- tion of institution level and individual-level data [19, 20]. Data on the women, their pregnancy, labor and delivery were extracted from hospital and medical records into a standard one-page data collection form. Given that data were collected on all women at each participating site, the QUARITE investigators kept the data collection in- strument relatively short in order to minimize the bur- den of the trial on health professionals working at the study sites. Trained midwives collected the data from medical records at each site. National coordinators
The participants were assessed on a number of indicators; demographics, questions on knowledge domain, questions on attitude domain, and questions on practice domain. In our construct, the knowledge section consisted of 20 factual statements to assess various indicators of hypothyroidism, including the symptoms, risk factors, diagnosis, and treatment. The responses were captured through two options, in a yes and know response. The shortened response mechanism was chosen to increase the response rate and to ensure that the participants spent the least amount of time on each of the questions. In the attitude segment of the research, 5 questions were administered to the patients to validate a range of response on attitude towards hypothyroidism and treatment to the condition. However, for this section, the study adopted a 5-point Likert scale to assess the response of the participants; the Likert scale was used to rank the responses of the participants. In the practice domain, the study had eight practice statements with a yes or no answer. The patients were assessed if they could pursue a certain or recommended practice.
All study participants met the following eligibility criteria: $18 years of age; living in the United States at the time of survey completion; able to read English; had a self-reported physician-based diagnosis of MS; and had used fingolimod as treatment for MS. In addition, all participants were required to provide informed consent before completing the survey. In order to obtain an adequate sample size and given that fingolimod had been on the market for less than 2 years at the time of the survey, the date of fingolimod initiation was not included as a part of the study inclusion/exclusion criteria.
ited to, for instants; the committee updated and added more five hundred new line items. The committee updated primary care medical list, updated Cardiopulmonary Resuscitation (CPR) medication list for adults and pediat- ric. The committee added a ready-made, fixed standard concentration of some CPR medica- tion. The committee supports the Implemen- tation of the medicines safety program. Also, the updated some pharmacy services including intravenous admixture services at more thirty hospitals. [8,9] In the study, the authors utilized
It is hence not surprising that these components were the most significant in our multivariate analysis, and therefore these findings underscore the importance of history of hyperten- sion and high WC as key determinants of prevalent metabolic syndrome and can be used to identify at-risk individuals in resource-limited settings. Moreover, according to the con- sensus document of the European Society of Hypertension working group on hypertension and cardiovascular risk in low resource settings, screening and treatments programs ought to be based on cardiovascular risk stratification, rather than focusing on the single risk factor such as untreated hyperten- sion. 29 Thus in a clinical setting, the history of hypertension
This study has four main limitations. Firstly, we fo- cussed only on selected key functions of CEmONC (cae- sarean section and blood transfusion), and did not include signal functions such as basic neonatal resuscita- tion which are part of both BEmONC and CEmONC. Secondly, the cross-sectional design of our study pre- vents us from detecting trends in the capacity of district hospitals to provide C-section and blood transfusion services. Thirdly, for some variables of our study (ex- perience with quality assurance approaches, availability of human resources etc.), we relied on interviews instead of documentary evidence, like health facilities statistics. Lastly, we operationally define the availability of blood transfusions as continuous when provided by a blood bank, which may not always be a valid definition.
The city of Johannesburg is the geographic and eco- nomic centre of southern Gauteng province. There are 18 government hospitals with maternity services in southern Gauteng, with about 100 000 births per annum. Three of these hospitals are university-attached tertiary referralhospitals. The 13 hospitals in the study included the three tertiary hospitals, as well as seven re- gional referralhospitals, and three district hospitals. The district hospitals are staffed by non-specialist doctors and have relatively small case loads. The regional hospi- tals all have at least one specialist, as well as medical of- ficers who are responsible for most of the daily clinical activities. The tertiary hospitals are better resourced in terms of equipment and facilities, and include university faculty staff and residents training to become specialists.
Determinants of client satisfaction to skilled antenatal care services at Southwest of Ethiopia a cross sectional facility based survey RESEARCH ARTICLE Open Access Determinants of client satisfaction[.]
Adjusted odds ratios (aORs) associated with β from these regression were used to measure urban-rural and socioeconomic inequalities in access to C-sections. We first used an aOR, which is commonly applied in health and social sciences to measure inequalities [32, 33]. The OR here represents the odds of having a C-section (pro- portion of women who had a C-section divided by the proportion of women who did not have a C-section) in the least advantaged categories (rural, non-educated or poorest) divided by the odds of having a C-section in the most advantaged category (urban, educated or richest). An OR below 1 indicates inequalities in favour of the least advantaged categories (they are more likely to have C-section than the most advantaged categories), a value over 1 indicates inequalities in favour of the most advantaged categories (they are more likely to have a C-section than the least advantaged categories), and an OR equal to 1 indicates an equal distribution of C-sections among all women. Using logistic regression models, we calculated aORs on variables selected a priori as potentially affecting C-sections (area of resi- dence, maternal age, education level, wealth quintile of household, parity, multiple pregnancy) and considered sampling weight, clustering and strata.
A unique study number was assigned to each participant and used for the storage and management of all data re- lating to that patient. The data were captured using Stat- istical Package for Social Sciences (SPSS) version 16.0. Cleaning of data was done using standardised queries to conduct range and logic check. Discrepant entries were rectified by reviewing the record form. The data was exported into STATA version 11 (StataCorp, Texas, USA). The results were expressed as means and standard deviations (SD) for continuous variables and percentages for categorical variables such as age and sex. Statistical significance was accepted at a 5% probability level, that is, a p-value of less than 0.05. Cross tabulations and mul- tiple response analysis were carried out where necessary. Logistic regression was also carried out to determine fac- tors associated with poor perception of caesareansection among women attending the antenatal clinic.
A hospital-based, cross-sectional study was conducted between January and June 2019 in Dar es Salaam ter- tiary hospitals, including Muhimbili National Hospital (MNH), Mwananymala Referral Hospital, Amana and Mloganzila Hospital, to determine the utilization pattern of chemoprophylaxis against malaria in children with SCD. All children with SCD below 18 years of age attend- ing sickle cell clinic in Dar es Salaam tertiary public hos- pitals were eligible to participate in this study. Tertiary hospitals are the only hospitals in Dar es Salaam to con- duct weekly sickle cell clinics.
of patients. The survey also included only those patients who were consulting their physician and, as such, the generaliz- ability of the findings to the COPD population as a whole is unknown. Furthermore, our study enrolled patients present- ing within both primary and specialist care settings and was not designed to evaluate potential differences in night-time symptoms and sleep disturbance between these two groups. Given the reasonable assumption that patients managed under specialist care were more severely affected by COPD, higher rates of sleep disturbance may perhaps have been anticipated among these patients.
individual factors where there may be other factors related to supporting the ban in bars. In addition, as with all cross- sectional studies, none of the results assumes causality. Further research is needed to support recommendations in order to make evidence-driven policy decisions to maximize effectiveness of WHO FCTC outcomes. Qualitative analysis may contribute to explain how older age, regardless of lower education and smoking status, is associated with support of the ban in bars.
A multicenter cross-sectional study conducted in Brazil revealed that 68.7% of near misses were associated with delays . Another study in Gabon reported that 40% of women delayed more than 45 min before seeing any qualified personnel . Having nearby health facility and access to transport improves utilization of maternal health services which could reduce near misses related to the delays . Hence, this study was aimed to iden- tify the magnitude of maternal near miss and the role of delays which provide insights for stakeholders in decision making and policy development.
institutions. The higher institutions like teaching hospitals are expected to have well equipped NICU for care of sick premature newborns. Ayder referral hospital is one of the teaching and tertiary care levels in Northern Ethiopia. As it serves referrals from different newborn corners and second level NICU there are many premature infants. Therefore, this study aimed to assess Preterm neonatal deaths and associated factors among premature newborns in Ayder Referral hospital, North Ethiopia. The findings of this study might be useful for policy makers and NGOs working on preterm infants and also important as background or baseline information for researchers who are interested in these areas.
Patient characteristics by GOLD group are shown in Table 1. Overall, the average age was 65.8 years. Patients in group D had the highest mean age consistent with later stage COPD and a more comorbid profile. The majority of patients were male (68.1%) and .90% of patients were Caucasian. Approximately 50% of patients were receiv- ing specialist care, which increased to 60% for patients in group D. Overall, 20.6% of patients had been diagnosed within #12 months of participating in the survey, with the lowest proportions of recently diagnosed patients in groups C and D (9.1% and 12.8%, respectively). In group B, 29.8% of patients had experienced one exacerbation in the previous 12 months, compared with 12.6% for group A.
Community pharmacists are among the most accessible health professionals . As such, they can play a special role in reducing antibiotic resistance . They are recognized as drug experts. Thus, they can inform patients and pre- scribers about the rational use of antibiotics . Given their role as communi- cators advocated in the concept of “seven-star pharmacist” , they can partic- ipate in the promotion of health by raising awareness about healthy lifestyles such as hand washing and vaccination . However, the knowledge and skills of community pharmacists about antibiotics use should be strengthened so that they can fully fulfill these functions. For this purpose, studies are necessary to identify the shortcomings and therefore the training and awareness areas. How- ever, in Senegal, any study has not been conducted to determine the level of un- derstanding of pharmacists about antibiotic use and its implications for public health. Our goal was to assess the community pharmacists’ knowledge, practices and perceptions about antibiotic use and resistance.