scholarly journals Impact of Followup Visits on the Integrated Management of Childhood and Neonatal Illness Strategy Implementation in the Health Facilities of District Jamshoro

2020 ◽  
Vol 19 (02) ◽  
pp. 87-92
Keyword(s):  
Integrated Management ◽  
Strategy Implementation ◽  
Health Facilities

scholarly journals Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Ehsanur Rahamn ◽  
Shema Mhajabin ◽  
David Dockrell ◽  
Harish Nair ◽  
Shams El Arifeen ◽  
...  
Keyword(s):  
Public Health ◽  
Distribution System ◽  
Integrated Management ◽  
Child Death ◽  
Health Facilities ◽  
Family Welfare ◽  
Service Availability ◽  
District Health ◽  
Public Health Facilities ◽  
District Hospitals

Abstract Background With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as ‘essential’ for pneumonia management. Results More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8–10), whereas 20% had a low-readiness (score 0–4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). Conclusion There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.

scholarly journals Antibiotics prescription for febrile patients: associated factors in a health facility-based survey in the Greater Accra region of Ghana

2019 ◽  
Author(s):  
Michael Mireku Opoku ◽  
Harriet Affran Bonful ◽  
Kwadwo Ansah Koram
Keyword(s):  
Integrated Management ◽  
Blood Film ◽  
Health Facilities ◽  
Full Blood Count ◽  
Baseline Survey ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Laboratory Investigations ◽  
Greater Accra Region

Abstract Introduction: Frequent and/or misguided prescription of antibiotics are important facilitators of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may increase out of proportion to requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the proper use of antibiotics. The objective of this study was to determine the factors associated with of antibiotics prescription to febrile patients who seek care in health facilities within the Greater Accra region of Ghana. Methods: Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 were used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotics prescription. Results: The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing. Conclusion: Prescription of antibiotics to febrile patients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

scholarly journals Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053412
Author(s):  
Josephine Birungi ◽  
Sokoine Kivuyo ◽  
Anupam Garrib ◽  
Levicatus Mugenyi ◽  
Gerald Mutungi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Hiv Infection ◽  
Integrated Care ◽  
Plasma Viral Load ◽  
Integrated Management ◽  
Retention In Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Sub Saharan

BackgroundHIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.ObjectivesTo determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators.Design and settingProspective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala.InterventionClinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments.Primary outcome measuresRetention in care, plasma viral load.FindingsBetween 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478.ConclusionIntegrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

scholarly journals HUBUNGAN PELAYANAN DAN FASILITAS KESEHATAN DENGAN KEPUASAN PASIEN PADA PELAYANAN MANAJEMEN TERPADU BALITA SAKIT (MTBS) DI PUSKESMAS KARYA TANI KABUPATEN LAMPUNG TIMUR

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
M. Arifki Zainaro ◽  
Dewi Kusumaningsih ◽  
Karyanto Karyanto
Keyword(s):  
Public Health ◽  
Patient Satisfaction ◽  
Health Center ◽  
Health Workers ◽  
Integrated Management ◽  
Statistical Test ◽  
Health Facilities ◽  
P Value ◽  
Cross Sectional ◽  
Public Health Center

ABSTRACT : CORRELATION BETWEEN SERVICES AND HEALTH FACILITIES WITH PATIENT SATISFACTION ON INTEGRATED MANAGEMENT OF CHILDHOOD ILLNES (IMCI) SERVICE AT KARYA TANI’S PUBLIC HEALTH CENTER DISTRICT  Background : The Purpose is on integrated management of childhood illnes (IMCI)  significantly reduce the mortality and morbidity associated with the most common diseases in infants. Contribute to the growth and development of children's health. Achievement indicators of health care of children under five in 2016 amounted to 75.82% do not meet the Strategic Plan targets by 83%. The achievement of this indicator also decreased compared to 2015, which amounted to 70.12%.Purpose: To know correlation between service and health facility patien satisfaction on integrated management of childhood illnes (IMCI) At Karya Tani’s Public Health Center District East Lampung 2018Methods: Quantitative research type, analytic research design with cross sectional approach. The population is all mothers with toddlers who perform the examination with average visits per month as many as 63 people. The statistical test used was the statistical test Chi-Square.Results: Frequency distribution of patient satisfaction, with dissatisfied category as many as 34 respondents (54%). Distribution of service frequency, with less good category as many as 36 respondents (57.1%). Distribution of frequency of health facilities, with poor category as many as 25 respondents (39.7%).Conclusion : There is a correlation service with patient satisfaction Integrated Management of childhood  Pain (IMCI). The results obtained (p-value 0.0001 <α 0.05) with the value of OR 18,229. It is expected that Puskesmas Karya Tani can provide training on integrated management of childhood illnes (IMCI) to health workers as well as providing facilities and infrastructure especially for Integrated Management of Childhood (IMCI). Keyword                        : Service Health Facilities, Patient Satisfaction, IMCI

scholarly journals Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi

2018 ◽  
Vol 3 (2) ◽  
pp. e000506 ◽  
Author(s):  
Omolara T Uwemedimo ◽  
Todd P Lewis ◽  
Elsie A Essien ◽  
Grace J Chan ◽  
Humphreys Nsona ◽  
...  
Keyword(s):  
Child Mortality ◽  
Low Income ◽  
Guideline Adherence ◽  
Integrated Management ◽  
Care Quality ◽  
Health Facilities ◽  
Childhood Illness ◽  
Sub Saharan Africa ◽  
Adjusted Relative Risk ◽  
Pneumonia Diagnosis

BackgroundPneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi.MethodsData were obtained from the 2013–2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity.Results3136 clinical visits for children 2–59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity.ConclusionsCare quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.

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