scholarly journals Health system actors’ perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study

PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0235513 ◽  
Author(s):  
Nondumiso B. Q. Ncube ◽  
Lucia Knight ◽  
Hazel Anne Bradley ◽  
Helen Schneider ◽  
Richard Laing
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Health System ◽  
Health Facilities ◽  
Prescribing Practices ◽  
Public Health Facilities

scholarly journals Analysis of patterns of antibiotic prescribing in public health facilities in Nepal

2020 ◽  
Vol 14 (01) ◽  
pp. 18-27 ◽  
Author(s):  
Anant Nepal ◽  
Delia Hendrie ◽  
Suzanne Robinson ◽  
Linda A Selvey
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Antibiotic Prescribing ◽  
Who Guidelines ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Middle Income ◽  
Public Health Facilities ◽  
Inappropriate Use

Introduction: Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. Little is known about antibiotic prescribing practices at public health facilities in low- and middle-income countries. We examined patterns of antibiotic prescribing in public health facilities in Nepal and explored factors influencing these practices. Methodology: A cross-sectional study of antibiotic prescribing in public health facilities was conducted in the Rupandehi district of Nepal. Six public health facilities were selected based on WHO guidelines, and data were extracted from administrative records for 6,860 patient encounters. Patterns of antibiotic prescribing were investigated using descriptive statistics. Chi-squared tests and logistic regressions were applied to explore factors associated with antibiotic prescribing. Results: Of patients attending public health facilities, the proportion prescribed at least one antibiotic (44.7%) was approximately twice the WHO recommended value (20.0 to 26.8%). The antibiotic prescribing rate for hospital inpatients (64.6%) was higher than for other facilities, with the prescribing rate also high in primary health care centres (50.4%) and health posts (52.2%). The most frequently (29.9%) prescribed antibiotic classes were third-generation cephalosporins. Females (p = 0.005) and younger (p < 0.001) patients were more likely to be prescribed antibiotics. High prescribing rates of antibiotics for selected diseases appeared contrary to international recommendations. Conclusion: Antibiotic prescribing in public health facilities was high compared with WHO guidelines, suggesting the need for strategies to reduce misuse of antibiotics. This study provides useful information to assist in formulating policies and guidelines to promote more appropriate use of antibiotics in Nepal.

scholarly journals Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042389
Author(s):  
Siddesh Sitaram Shetty ◽  
Kusum Venkobrao Moray ◽  
Himanshu Chaurasia ◽  
Beena Nitin Joshi
Keyword(s):  
Public Health ◽  
Health System ◽  
Annual Cost ◽  
Postpartum Haemorrhage ◽  
Public Health System ◽  
Health Facilities ◽  
Health Management Information System ◽  
Public Health Facilities ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

ObjectivePostpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India.DesignHealth system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.SettingsFour public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.Outcome measuresUnit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017–2018.ResultsMedical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596).ConclusionsAtonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state’s annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.

scholarly journals EVALUATION OF DRUG-PRESCRIBING PATTERNS AT OUTPATIENT CLINICS OF PUBLIC HEALTH FACILITIES IN MIRPUR AZAD KASHMIR

2021 ◽  
Vol 71 (4) ◽  
pp. 1243-47
Author(s):  
Saman Omer ◽  
Bushra Tayyaba Khan ◽  
Omer Jalil
Keyword(s):  
Public Health ◽  
Health Facilities ◽  
Prescribing Patterns ◽  
Essential Medicines ◽  
World Health ◽  
Drug Prescribing ◽  
Prescribing Practices ◽  
Prescribing Pattern ◽  
Prescribing Indicators ◽  
Public Health Facilities

Objective: To evaluate prescribing practices in public health facilities of district Mirpur, Kashmir where no previous evidence regarding drug-prescribing behaviours was available. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Methodology: The prescribing pattern analysis was done by objective observations of prescriptions after patient-physician encounter. World health organization defined core and complementary prescribing indicators were evaluated for all the prescriptions. Results: Among the core prescribing indicator, average number of medicines per prescription were 3.11 (World Health Organization’s standard, 1.6-1.8). Only 2% and 67% of medicines were generic and essential medicines respectively (standard, 100%). Almost half the prescriptions contained antibiotics (standard, 20-26.8%) whereas 8% had injections (standard, 13.4- 24.1%). Among the complementary indicators there was no prescription without medicines and average prescription cost was 479 Pakistani Rupees. Conclusion: This is the first study to give a snapshot of prescribing behaviours in public health facilities in Kashmir. All the prescribing indicators except injectables were below the standards. A multi-disciplinary approach involving authorities, industry and professionals is required to promote rational prescribing.

scholarly journals Patients’ Perspectives on Their Safety: A Qualitative Study in Two Public Health Facilities in Kaduna State, Nigeria

2021 ◽  
Vol 16 (2) ◽  
pp. 101-109
Author(s):  
B.K. Lawal ◽  
S. Mohammed ◽  
M.A. Ladan ◽  
B.B. Maiha ◽  
A.A. Aliyu ◽  
...  
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Sampling Technique ◽  
Healthcare Services ◽  
Health Facilities ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Public Health Facilities ◽  
Healthcare Environments ◽  
Medical Wards

Background: Safe healthcare environments influence patients’ valuation of care received and impact on better health outcomes. It has been recognized that patients can contribute invaluably in improving the quality and safety of healthcare services they receive.Objective: To explore the perspectives of patients on their safety in healthcare.Methods: A qualitative study comprising of four (4) focus group discussions (FGDs) with six to eight participants was conducted in two public health facilities in Kaduna State, Nigeria. Patients admitted in medical wards (male and female) were recruited through a purposive sampling technique after obtaining their verbal informed consent to participate. A topic guide, containing open ended questions that explored patients’ opinions on their safety in healthcare was used for the discussions. All FGD sessions were recorded, transcribed and coded using thematic analysis.Results: The participants consisted of 15 females and 13 males in FGD sessions that lasted between 55 to 90 minutes. All participants were Hausa speaking, with varying levels of education. Six (6) themes were generated which the patients perceived to play a role in their safety in healthcare. These themes are: choice of hospital, patient satisfaction, patient experiences, patient engagement, communication openness and suggestions by patients for improvement.Conclusion: The findings of this study have highlighted both positive and negative perspectives of patients regarding their safety in healthcare. The patients provided some recommendations for areas where improvements are required for improved patient safety. These include infrastructural improvements, staffing, and availability of medicines, amongst others.

scholarly journals Integration of HIV-Sexual Reproductive Health Services for Young People and the Barriers at Public Health Facilities in Mbarara Municipality, Southwestern Uganda: A Qualitative Assessment

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Cecilia Akatukwasa ◽  
Francis Bajunirwe ◽  
Simpson Nuwamanya ◽  
Noel Kansime ◽  
Emmanuel Aheebwe ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Young People ◽  
Reproductive Health ◽  
Health System ◽  
Health Facilities ◽  
Qualitative Assessment ◽  
Care Providers ◽  
Public Health Facilities ◽  
Southwestern Uganda

Background. Sexual and Reproductive Health (SRH) and HIV risk behaviors for young people are intertwined. This rationalizes the need for integration of HIV and SRH services within the health care system, especially in countries with high HIV burden. In this study, we explored the current status of HIV-SRH integration for young people and barriers of integration from different stakeholders at public health facilities in Mbarara Municipality, southwestern Uganda. Methods. We conducted an exploratory qualitative study at public health facilities in Mbarara district of southwestern Uganda. Data were collected among young people (n=48), health care providers (n=63), and key informants (n=11). We used in-depth interviews and focus group discussions to collect the data. Coding and analysis of qualitative data were done using Atlas.ti. Results. Overall there was no differentiation of HIV-SRH services between adults and young people. Integration of HIV-SRH services was reported at all facility levels; however, there was poor differentiation of services for the young persons and adults. Integrated HIV and SRH services for young people were acknowledged to improve access to information and risk perception, improve continuity of care, and reduce cost of services and would also lead to improved client-health worker relationships. The potential barriers to achieving HIV-SRH integration included individual provider characteristics like lack of training and attitudes, generic health system challenges like low staffing levels, poor infrastructure with lack of space and privacy to deliver these services. At the policy level vertical programing and unclear policies and guidelines were identified as challenges. Conclusion. Our study shows integration of HIV and SRH services exists in general but services for adults and young people are blended or poorly differentiated. Significant health system barriers need to be overcome to achieve differentiation of the services for young people and adults.

scholarly journals Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
David Musoke ◽  
Carol Namata ◽  
Grace Biyinzika Lubega ◽  
Freddy Eric Kitutu ◽  
Lawrence Mugisha ◽  
...  
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Animal Health ◽  
Health Facilities ◽  
Community Level ◽  
Household Waste ◽  
Community Members ◽  
Public Health Facilities ◽  
Inappropriate Use ◽  
Drug Shops

Abstract Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda. Methods A qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national AMR surveillance committee. Twelve FGDs were held (8 for CHWs and 4 for farmers) while 15 KIIs were conducted. Thematic analysis in NVivo (version 12) was performed. Results Five main themes emerged from the study: access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials. Community members mainly accessed antimicrobials for humans from public health facilities such as government health centres, as well as private facilities, including drug shops and clinics. Antimicrobials for animals were obtained from veterinary practitioners and drug shops (both for humans and veterinary). Examples of inappropriate use of antimicrobials in both humans and animals was evident, such as sharing antibiotics among household members, and giving human-prescribed antimicrobials to food-producing animals as growth promoters. While some CHWs returned unused antimicrobials to public health facilities for proper disposal, community members mainly disposed of antimicrobials with general household waste including dumping in rubbish pits. Conclusions There is a need to increase awareness among the population on proper access, use and disposal of antimicrobials for both humans and animals. Development of a drug disposal system at community level would facilitate improved waste management of antimicrobials. Together, these measures would help prevent the rate of progression of AMR in communities.

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