scholarly journals The Challenges of Directly Observed Treatment Shortcourse (DOTS) Implementation for Tuberculosis Management in Anambra State, Nigeria: A Comparative Analysis

Author(s):  
M. C. Ohamaeme ◽  
C. C. Ibeh ◽  
J. N. Egwurugwu ◽  
S. D. Ejikunle ◽  
C. Aniemena ◽  
...  

Aim: Several challenges have been hampering the DOTS strategy ranging from a paucity of staff, laboratory consumables and drugs among others. This study, therefore, assessed the challenges facing TB-DOTS implementation in Anambra State, Nigeria. Study Design: A cross-sectional analytic study was carried out. Place and Duration of Study: TB-DOTS accredited facilities in Anambra State, South-East Nigeria, September 2017 - March 2018. Methodology: Using questionnaires on 354 respondents, a checklist on 32 DOTS accredited facilities, and Key In-depth Interview (KII) guide which was administered on 14 focal persons in rural and urban facilities, including the State TBL coordinator, was employed. Data were analysed using Chi-square and Fisher`s exact test with level of significance set at p<0.05, while key themes from KII were thematically analysed. Results: Both urban and rural respondents took nearly the same time to reach a DOTS centre, however, urban respondents spent more money to reach a TB centre and this was statistically significant p≤0.002. Patients stated that the DOTS strategy could be improved by attending to them early, home visiting, having more staff, providing pocket money among others in urban compared to rural areas and these were statistically significant p≤0.003. Checklist revealed that most patients in rural facilities 16/19(84.2%) compared to urban 11/13(84.6%) were not observed taking their medications while 11/19(57.9%) rural compared to 5/13(38.5%) urban had no functional microscope. Both rural and urban facilities specifically had challenges of Genexpert machines, needed more staff and laboratories as well as adequate funds and retraining. Conclusion: Challenges of DOTS may be myriad, however, Focal persons and Health workers should ensure direct observation of patients while the STBL coordinator informs government and policymakers on the need to employ more workers in TB management to help reduce waiting time. Regular training and retraining of health workers are also recommended.

2019 ◽  
pp. 30-57
Author(s):  
M.C. Ohamaeme ◽  
C.C. Ibeh ◽  
O.F. Emelumadu ◽  
N.N. Ezeama ◽  
U.C. Anyanwagu ◽  
...  

Background: The Directly Observed Treatment Shortcourse (DOTS) is a widely accepted strategy in the management of TB, however, Failure cases and Multi-drug resistant cases are also on the increase, hence the need to assess the adherence to the implementation of this veritable strategy from providers and patients views. Methodology: A comparative cross-sectional study involving 32 DOTS accredited facilities in rural and urban areas implementing DOTS strategy was utilized for this study. A total of 354 were randomly selected and assessed with the use of a questionnaire while a checklist was used to assess providers’ adherence. Data was analysed using SPSS version 21. Chi-square and Fisher`s exact test was used to test significance set at p<0.05. Results: The rural respondents spent less to get to the DOTS facility and this was statistically significant (p=0-02). The reasons for missing medications in rural compared to urban areas was also statistically significant (p=0.00). No health worker was noted to observe patients other than parents or siblings from the questionnaires and this was also statistically significant, (p=0.03). Overall patients adherence was 86.2% in rural compared to 87.6% in urban areas which was higher. None of the facilities in both subpopulations had health education checklist and one rural facility drug that passed expiration date was also seen. Conclusions: Overall adherence to DOTS implementation was high in both subpopulations, however, no health worker observed the patients. Direct observation of patients and follow-up is strongly recommended to prevent failure and resistant cases. Key words: Implementation; DOTS strategy; Providers adherence; Patients adherence; Anambra State.


Author(s):  
M. C. Ohamaeme ◽  
F. Ilika ◽  
C. C. Aniagboso ◽  
M. U. Elendu ◽  
C. R. Aniemena ◽  
...  

Background: This study assessed the level of satisfaction of patients with TB implementation in selected DOTS accredited facilities. Methodology: A comparative cross-sectional analytic study involving rural and urban areas implementing DOTS for TB in Anambra State was done. A total of 354 respondents (177 per sub population) were enrolled in the study. By exit interview respondents were administered the questionnaire that bordered on services rendered and cost implications of accessing treatment at the facilities. Results: A total of 162(91.5%) rural respondents were satisfied with appropriateness of working hours compared to 166(93.8%) participants in urban areas. Also 141(79.7%) respondents in rural areas were satisfied with waiting time compared to 155(87.6%) in urban areas and this was statistically significant p<0.004. For the cleanliness of the specimen bottle 138(77.8%) rural respondents compared to 148(83.6%) in urban areas were satisfied and this was statistically significant, p<0.001. Majority of the urban respondents 123(68.9%) were satisfied with respect offered by health workers compared to rural 114(64.4%), and this was also significant, p<0.000. Concerning cost incurred and information given by health workers more urban respondents 5(2.8%) were dissatisfied compared to rural 2(1.1%) though not statistically significant p= 0.378. However, satisfaction was slightly higher in urban (82.8%) compared to rural (80.8%) respondents, while the overall satisfaction in this study was 81.8%. Conclusion: Patient`s satisfaction is a panacea for successful DOTS implementation. We therefore recommend that satisfaction could be improved by provision patient-centred requests such as provision of multivitamins, transport, food among others to help improve DOTS because it will encourage attendance and adherence with better outcomes.


2020 ◽  
Vol 8 (2) ◽  
pp. 93
Author(s):  
Citra Al Karina ◽  
Christyana Sandra ◽  
Yennike Tri Herawati

Abstract PKPR is a program developed since 2003 at the primary care level aimed as well as for access by teenagers to improve the health status of adolescents since. PKPR implemented since 2007 in 11 health centers in the regency and already strata. Visit data utilization in the 15-19 age PKPR, KIE activities amounted to 14.26%; health care amounted to 76.75%; and counseling by 1.71%; as well as with the achievements of PKPR utilization of 92.72% (33 224 adolescents) who has yet to reach the expected target is equal to 100%.The purpose of this study to analyze the factors that affect the utilization PKPR by school adolescents (15-19 years) in the working area of ​​the regency health centers in 2019. This research is an analytic research with cross sectional design where data collection is done at one time. The research samples 96 adolescent proportioned Tlogosari health center, tamanan and Maesan the regency with the technique multistage sampling, Data were obtained through a questionnaire and documentation study. Data was analyzed using statistical test of chi-square or fisher's exact test and logistic regression in the form forward with a significance level α = 0.05. The results showed that the statistical chi-square test and Fisher's exact test for the predisposing characteristics, namely there is no influence of age (p = 0.554); gender (p = 0.853); level of education (p = 0.348); and knowledge (p = 0.584). Enabling characteristics of no effect, the ownership of health insurance (p = 0.784) and accessibility to health care (p = 1.000); and there are significant variables is the availability of health workers (p = 0.002) and health care (p = 0.000), the competence of health professionals (p = 0.002), and the time/speed of service (p = 0.012). Factors needs (perceived need) no effect (p = 1.000). The test results of multivariate logistic regression with forward stepwise method (likelihood ratio) is the most influential factor on the utilization PKPR is not available health facilities (p = 0.045) and less competent health workers (p = 0.001).   Keywords: PKPR program, utilization PKPR, youth, access   Abstrak PKPR ialah suatu program yang dikembangkan sejak tahun 2003 di tingkat puskesmas yang ditujukan serta untuk diakses oleh remaja guna meningkatkan status kesehatan remaja sejak. PKPR dilaksanakan sejak tahun 2007 pada 11 puskesmas di Kabupaten Bondowoso dan sudah strata. Data kunjungan pemanfaatan PKPR usia 15-19 tahun pada kegiatan KIE sebesar 14,26%; pelayanan kesehatan sebesar 76,75%; dan konseling sebesar 1,71%; serta dengan capaian pemanfaatan PKPR sebesar 92,72% (33.224 remaja) yang masih belum mencapai target yang diharapkan yaitu sebesar 100%. Tujuan penelitian ini untuk menganalisis faktor yang mempengaruhi pemanfaatan PKPR oleh remaja sekolah (15-19 tahun) di wilayah kerja puskesmas Kabupaten Bondowoso tahun 2019. Penelitian ini merupakan penelitian analitik dengan desain cross sectional dimana pengambilan data dilakukan pada satu waktu. Sampel penelitian 96 remaja yang diproporsikan pada Puskesmas Tlogosari, Tamanan dan Maesan Kabupaten Bondowoso dengan teknik multistage sampling. Data diperoleh melalui angket  kuesioner dan studi dokumentasi. Analisis data dilakukan dengan uji statistik chi-square atau fisher’s exact test dan regresi logistik berupa forward dengan tingkat signifikansi α = 0,05.  Hasil penelitian menunjukkan bahwa uji statistik chi-square dan fisher’s exact test untuk karakteristik predisposisi tidak terdapat pengaruh yaitu umur (p=0,554); jenis kelamin (p=0,853); tingkat pendidikan (p=0,348); dan pengetahuan (p=0,584). Karakteristik enabling tidak terdapat pengaruh yaitu kepemilikan asuransi kesehatan (p=0,784) dan aksesibilitas menuju pelayanan kesehatan (p=1,000); serta variabel yang terdapat pengaruh ialah ketersediaan tenaga kesehatan (p=0,002) dan fasilitas kesehatan (p=0,000), kompetensi tenaga kesehatan (p=0,002), dan waktu/kecepatan pelayanan (p=0,012). Faktor kebutuhan (perceived need) tidak terdapat pengaruh (p=1,000). Hasil uji multivariat regresi logistik dengan metode forward stepwise (likelihood ratio) faktor yang paling berpengaruh terhadap pemanfaatan PKPR adalah tidak tersedia fasilitas kesehatan (p=0,045) dan tenaga kesehatan kurang kompeten (p=0,001).   Kata Kunci: program PKPR, pemanfaatan PKPR, remaja, akses


2020 ◽  
Vol 23 (1) ◽  
pp. 41-47
Author(s):  
Putu Inge Ruth Suantika ◽  
Yanti Hermayanti ◽  
Titis Kurniawan

The lack of interest from the public and health workers, such as nurses to carry out a pap test, is one of the triggers of cervical cancer cases. The purpose of this study was to identify the implementation of pap tests and barriers of nurses in Bandung, West Java. This study used a cross-sectional descriptive study design with a sample of 286 married nurses. Data collection was conducted during two months. The analysis was conducted by the Fisher exact test or chi-square test. The results showed that the level of education and religion had a significant relationship with the pap test behavior (p= 0,000; p= 0.031). The most perceived barrier was that respondents felt uncomfortable with the male examiners. So it was recommended to provide female examiners in the ob-gyn section in the hospitals and to improve the nurses' perceptions with pap test. Keywords: barrier, nurse, pap smear, practice Abstrak Perilaku dan hambatan pap smear pada perawat di Kota Bandung, Jawa Barat. Fenomena yang terjadi pada kasus kanker serviks adalah minimnya minat dari masyarakat bahkan petugas kesehatan seperti perawat untuk melakukan pap smear sebagai bentuk pencegahan kanker serviks. Tujuan penelitian ini adalah untuk mengidentifikasi pelaksanaan pap smear serta hambatannya pada perawat di Kota Bandung, Jawa Barat. Penelitian ini menggunakan desain studi deskriptif cross-sectional dengan jumlah sampel 286 perawat yang sudah menikah. Pengumpulan data dilakukan pada Februari hingga Maret 2018. Analisis menggunakan fisher exact test atau chi-square test. Hasil penelitian menunjukkan bahwa tingkat pendidikan dan agama memiliki hubungan yang signifikan dengan perilaku pap smear (p= 0.000; p= 0.0301). Hambatan yang paling dirasakan adalah responden merasa kurang nyaman dengan pemeriksa laki-laki sehingga direkomendasikan untuk penyediaan pemeriksa perempuan pada bagian obgyn di rumah sakit serta memperbaiki persepsi perawat yang salah terhadap pap smear.  Kata Kunci: hambatan, pap smear, perawat, perilaku


2017 ◽  
Vol 4 (2) ◽  
pp. 104-107
Author(s):  
Lailatul Khusnul Rizki

Constipation is one of the problems during the initial parturition intimately connected with the early ambulation. In the village of Tanah Kalikedinding still turned out a lot of postpartum mothers who cannot yet CHAPTER more than three days. The purpose of this research is to know the influence of early ambulation with the incidence of constipation in the mother post, in the village of Tanah KalikedindingSurabaya.This type of analytical research with cross sectional approach, its population is the entire mother childbirth > 3 days in the village of Tanah Kalikedinding as much as 28 people. A large sample of 26 respondents taken in “simple random sampling”. random sampling source this research obtained from the questionnaire. The independent variable is the dependent variable, while the early ambulation is the incidence of constipation. Analysis using Fisher Test with α = 0,05.The results showed that out of the 26 respondents obtained most of the 15 (57,7%) of respondents experiencing constipation. Test statistic chi-square obtained with 2 cells (50%) EF < 5. Therefore do exact test values obtained by exact fisherand P = 1 and a = 0,05 it means P >athe table then H0 is accepted means there's no intercourse means there is no influence of early ambulation with the incidence of constipation in the mother post.Summary of the research is there is no influenceof early ambulation with the incidence of constipation on postpartum mothers. We recommend that health workers should provide counseling for prevent constipation


2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Imandra Arif Bachtiar ◽  
Chilyatiz Zahroh

The habitual of Some mothers living around Posyandu Mojowuku tend not to provide their babies with measles immunization because of the perception that measles immunization can cause fever in babies. The fact that they do not receive information about immunization from the health workers creates a wrong perception that brings bad effects to babies. Hence, the purpose of this study was to find out the correlation between mother’s perception and measles immunization in babies aged over 9 months. This study was cross sectional approach involved the population of all mothers having babies aged over 9 months, totaling 63 couples. The samples of research 54 respondents were chosen using Non Probability sampling and Purposive sampling technique. Questionnaire and maternal-child health booklet were used to collect the data. Analyzed using Chi-Square test with the level of significance α = 0.05. The result showed that most of the mothers (66.7%) had positive perception about measles immunization, whereas most of the babies (70.4%) received measles immunization. Moreover, the result of Chi-Square test showed that ρ = 0,000 < so that H0 was rejected illustrating that there was a correlation between mother’s perception and measles immunization in babies aged over 9 months. Mother’s perception significantly affected the coverage of measles immunization in babies. Hence, those who have negative perception about measles immunization are expected to change their opinion and perception to avoid dangers for their babies. Moreover, the health workers are also expected to promote activities of providing them with health education to increase their awareness of measles immunization.


Author(s):  
Ionara Vieira Rocha Da Mota ◽  
Paulo Henrique Ribeiro Fernandes Almeida ◽  
Lucas Brasileiro Lemos ◽  
Mario Borges Rosa ◽  
Gisele Da Silveira Lemos

To analyze the errors of prescription and administration of antimicrobials powder for solution for injection in a public hospital. This is a cross-sectional study carried out in a public hospital, in which antimicrobials prescriptions and administrations were analyzed for patients admitted to the Intensive Care Unit (ICU) and Medical Clinic (CM) from November 2015 to February 2016. The tabulation and data analysis were done in Epidata software version 3.1 of 2008 and IBM Statistical Package for the Social Sciences (SPSS). In the statistical analysis, chi-square tests or Fisher’s exact test were applied when necessary. The level of significance was 5%. Among the statistically significant results, the following are the errors related to medical prescription with the variables: age at 57% and medical specialty at 67%, both at the ICU; bed with 30% and hospitalization unit with 37%, both in CM. In the administration of antimicrobials, statistically significant differences were observed only in the failure to identify the patient (30% in CM). Regarding the use of antimicrobials, Cefepime was the most prescribed with 65.1%. In view of these aspects, it is extremely important that errors arising from an incomplete and misleading prescribing are identified, to propose improvements in the medication system, in order to prevent errors, and to promote a more rational antibiotic therapy, avoiding infections.


2021 ◽  
Vol 7 (1) ◽  
pp. 12-18
Author(s):  
Fransiska Debataraja ◽  
Nova Sontry Node Siregar ◽  
Winta Mariana Batubara

Early Initiation of Breastfeeding (IMD) is an opportunity given to babies immediately after birth by placing the baby on the mother's stomach, then the baby is allowed to find the mother's nipple and breastfeed within the first hour after birth. The UNICEF organization Says that IMD is so important for babies that it calls it the baby's first vaccine. The purpose of this study was to determine the factors related to the implementation of Early Breastfeeding Initiation (IMD) at Butar Puskesmas, Pagaran District, Tapanulu Utara Regency in 2020. This type of research is a descriptive quantitative study using a cross sectional design or approach looking at the relationship between the independent and dependent variables. The total population of 30 people was used with a total sampling technique in which the entire population was sampled so that the sample size was 30 people. Data were collected by means of a questionnaire, then the data were processed using the chi-square test. The results of the study using the chi-square test with a confidence level of 95% (α = 0.05) showed that there was no relationship between the type of labor and the results of the Fisher's Exact Test with a confidence level of 95% and df = 1 obtained x2 count (0.597) <x2. table (3,841), there is a relationship of knowledge df = 2 obtained x2 count (10.425)> x2 table 5,991, there is a relationship between husband's support for Fisher's Exact Test with a confidence level of 95% (α = 0.05) and df = 1 obtained p value = 0.000 ( p <0.05), there is a relationship between support for health workers and df = 2, it is obtained x2 count (8,450)> n x2 table (5,991). It is expected that respondents will know the information provided by health workers or from the mass media about the provision and implementation of Early Breastfeeding Initiation (IMD).


2010 ◽  
Vol 3 (1) ◽  
pp. 127 ◽  
Author(s):  
Hukam Dad ◽  
Riasat Ali ◽  
Muhammad Zaigham Qadeer Janjua ◽  
Saqib Shahzad ◽  
Muhammad Saeed Khan

The major purpose of the study was to compare the frequency and effectiveness of positive and negative reinforcement practices deployed by teachers in boys’ and girls’ secondary schools in urban and rural areas. It was hypothesized that there would be no difference in use of reward and punishment by teachers in secondary schools in urban and rural areas with respect to their frequency and effectiveness. The results of this study brought out a clear picture of the reward and punishment practices being followed in schools, which may serve as a useful tool for improving these practices that influence development of students’ desired behaviour. The population of the study comprised of the teachers serving in government secondary schools of Punjab. A sample of 1,000 teachers (200 from district Rawalpindi, 150 from district Attock, 200 from district Lahore, 150 from district Gujranwala, 150 from district Multan, and 150 from district Khanewal) was randomly selected in such a way that the proportion of rural and urban boys’ and girls’ secondary school teachers was evenly balanced. In order to collect data from sample teachers, a comprehensive questionnaire was developed and personally administered. The data obtained was tabulated, analyzed and interpreted by using appropriate descriptive and inferential tests of significance, such as one-way chi-square and two-way chi-square. The level of significance was 0.05. On the basis of results and discussion, it was concluded that the teachers of urban schools had better knowledge of using reward and punishment with respect to their frequency and effectiveness as well. There should be a countrywide program to train teachers according to the demands of the new era.


Author(s):  
Sachina Paudel ◽  
Prabin Shrestha ◽  
Isha Karmacharya ◽  
Om Krishna Pathak

Abstract Background. The objective of this study was to assess the knowledge, attitude and practices of COVID-19 among Nepalese population, as containment of the disease is only possible with the change in behaviours as preventive measures. Methodology. A web-based cross-sectional survey was conducted for a period of two month among Nepalese residents aged ≥ 18 years using a previously validated tool. Unrestricted self-selected, convenient sampling method was adopted to generate a heterogeneous sample. Data were analysed in SPSS version 22 using chi-square/Fisher-exact test, independent t-test, multiple linear regression and binary logistic regression. Results. Out of 766 participants, 78.3% were aged 20–39 years and 58.2% were residents of province 3. One-third of the respondents were students followed by health workers. The rates for correct answer for COVID-19 knowledge questionnaire ranged from 30–99% with health workers and participants with bachelor’s degree having significantly better knowledge. Of the total participants, 71.5% agreed that COVID-19 will be effectively controlled and 80% were assured that Nepal could win the fight against COVID-19. The majority of the participants had not visited any crowded place (93.1%) which was significantly associated with age, marital status, gender, education, occupation, province of residence, and knowledge score of COVID-19 and 92.4% participants wore masks while going out which significantly differed across gender. Conclusion. There is a need to provide education and awareness about COVID-19 to Nepalese people focusing on the areas of knowledge gap so that Nepal can have victory against COVID-19.


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