158Prediction of diabetes and hypertension by opportunistic screening: A facility based study from rural Jodhpur

Background Nearly half of population with Diabetes and Hypertension is estimated to be undetected in India. The objectives of this study were to conduct opportunistic screening for Diabetes and Hypertension coming to OPD of health centres under Department of Community Medicine and Family Medicine, AIIMS Jodhpur, India and to develop the models for prediction of Diabetes and Hypertension. Methods Time bound study was conducted at three rural health centres between 2018-19. A total of 942 patients aged ≥30 years were screened. Data was recorded using Epicollect5. Risk assessment was done by using Indian Diabetes risk score (IDRS), Community based assessment checklist (CBAC), Waist Hip Ratio, & BMI. Random and fasting capillary blood sugar and BP was measured. Results The mean age of the participants was 52.4 ± 13.5 years. As much as 446 (47.4%) had IDRS score of ≥ 60 and 276 (29.3%) had CBAC score of ≥ 4. RBS level of ≥ 140mg/dl was found among 223 participants, of these, 42.5% were diagnosed to be diabetic on FBS. One-fourth (25.6%) were estimated to be hypertensive. Physical activity and hypertension were best predicting the diabetes (r2= 90.8), while hypertension was best predicted by age and BMI (r2= 74.3). Conclusions Prevalence of diabetes and hypertension was in accordance with the reported prevalence in the country. As compared to existing models, less number of prediction variables were identified for NCDs. Key messages The study highlights the need for implementation of hospital based opportunistic screening and point out the necessity to revise the existing prediction models for NCDs.

Practices and problems of female health/medical technicians in North-West Frontier Province, Pakistan

The Ministry of Health in Pakistan introduced in 1977 mid-level health workers called medical technicians to provide emergency aid and rudimentary services at basic health units and rural health centres. With the policy of placement of doctors in these units in the early eighties, their name was changed to health technicians, whose duties emphasized preventive activities instead of working as doctors’ substitutes. The objectives of this study were to estimate the percentage of graduated female technicians in the service, understand their reasons for not joining or leaving the service, appraise their practices in comparison to the expected performance, identify and report the academic and operational problems and recommend measures to resolve these problems and improve performance

Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres

Background Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. Methods A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome. Results We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13–0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99–9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00–4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22–6.86, p = 0.02). Conclusions This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90–70–90 targets by 2030 to be on track for cervical cancer elimination.

EFFECT OF DIFFERENT DIMENSIONS OF ORGANIZATIONAL CULTURE ON JOB SATISFACTION OF NURSES WORKING IN RURAL AREAS OF PUNJAB, PAKISTAN

Purpose of the study: The current study has explored the effect of different dimensions of organizational culture on the job satisfaction of nurses working in the rural areas of Punjab, Pakistan. Methodology: Present study used a cross-sectional, face-to-face approach. The researcher collected data from 452 nurses working at tehsil headquarter hospitals and rural health centres across Punjab with the help of an interview schedule. The effect of culture on the job satisfaction level of nurses Investigated with the help of Multiple regression techniques. Main Findings: The analysis showed a 52% variation in job satisfaction because of the culture. Values and belief systems, feedback systems, innovation, growth and development opportunities, relationship patterns, autonomy, work environment were the significant determinants of job satisfaction. Whereas the facilities, communication, and vision were the nonsignificant determinants of job satisfaction in the present study. Application of this study: The current research will be helpful to understand the prevailing culture of health care organizations. That will help the administrators and policymakers to understand the different factors which are responsible for low productivity. Novelty /originality of this study: The study is novel in organizational studies because it adopts a holistic approach to consider all the significant components of culture.

The Quality of Service Provision to Newborns in the Primary Healthcare, West Gojjam Zone, North-West of Ethiopia: A Cross-sectional Survey

Background: During 2019, neonatal conditions in Ethiopia accounted for 56% of under-5 deaths, with 33 neonatal deaths occurring for every 1,000 live births. More than 80% of all newborns deaths are caused by preventable and treatable conditions with available interventions. In Ethiopia, mortality rates for newborn babies have remained stubbornly high over the decades. Methods: A cross-sectional survey design was employed. Interviewer-administered questionnaires were administered to 221 health workers and health extension workers in 142 health facilities from April to July 2017. Data was entered in the EpiData 3.1, exported to SPSS and STATA for analysis. Results: Out of the ten quality of newborn care variables, 8.7 [95%CI: 6.03-11.303], the highest mean was achieved by primary hospitals, followed by urban health centres with a 6.4 mean [95%CI:5.168-7.601]. However, nearly half of the rural health centres were providing quality of newborn care at the mean of 5.7 [95%CI: 5.152-6.18], and below half was provided by health posts, 4.5 [95%CI: 3.867-5.116]. From the seven emergency newborn care signal functions, primary hospitals had a higher mean score, 6.3 [95%CI: 6.007-7.325] and rural health centres had a lowest mean score, 2.3 [95%CI: 2.043-2.623]. The availability of essential equipment is also significantly associated with the quality of neonatal care provision in the health facilities (p < 0.05). Overall, the effectiveness of the neonatal healthcare services has a significant association with the health facilitates readiness score [95%CI: 0.134-0.768]. Conclusion: The quality of newborn care was high at the higher-level health facilities and lower in the lower level health facilities such as rural health centres and health posts; where these facilities are designed to provide the newborn care services to the majority of the rural communities. In addition, the provision of emergency newborn care signal functions were critically low in rural health centres where these are a referral receiving health facilities from health posts. Thus, the rural health centres and health posts should be targeted to improve their readiness to provide the quality of services for newborns as per their expected level of care.

Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda

Background Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. Methods We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome. Results There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21–0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28–0.97). Conclusion Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.

The Potentials of a Maternal Mobile Wallet: a Qualitative Case Study on Opportunities and Challenges From Zimbabwe

Background: There are no systems put in place regarding mobile money for maternal savings in Zimbabwe. Therefore, this paper aims to highlight: (a) existing strategies and experiences about maternal savings in Kwekwe District and, (b) examine the implications of household dynamics and current savings behaviour towards the feasibility of implementing the RoadMApp Maternal Healthcare Mobile Wallet (MHMW). Methods: Out of the 49 health facilities in Kwekwe, 2 hospitals (rural and urban), 4 rural health centres, 2 peri-urban, and 2 urban clinics were purposively selected for the study. Participants were recruited from these health facilities. 193 people took part in the study, through 11 Focus Group Discussions, 17 In-Depth Interviews, and 3 Community Meetings. The Socio-ecological Model’s categories are applied to interpret the results taking into consideration the barriers and enablers of maternal savings.Results: There is a paucity of information on strategies for maternal savings in Kwekwe District, Zimbabwe. The critical enabler for the implementation of an MHMW could be the use of existing community structures, like the burial societies and other savings clubs. Some of the essential barriers include low access to mobile phones, inadequate network coverage, power outages, a general lack of saving culture by communities, and the hyperinflationary environment in the country. Conclusion: Although, the socio-economic status of households may be the best predictor of maternal savings, ancillary factors such as financial literacy, educational level, cultural norms, and religion will help to understand the psychosocial reasons why communities engage in maternal savings. When implementing an MHMW, specific attention should be paid to individual and community/institutional level factors such as subsidies/interests on amounts saved, enforcing financial discipline, building local level mobile network infrastructure, and relying on locally available persons/systems.

Occupational Psychosocial Factors in Primary Care Continuing Care Staff

This involves studying the psychosocial factors among the emergencies staff of primary care and seeing if there are differences with the primary health care staff at the Primary Care of the Integrated Care Management of Talavera de la Reina (Spain). Descriptive epidemiological study of type transversal. They have participated 51 emergencies staff of primary care and 50 primary health professionals from a sample of urban and rural health centres. The F-Psico 3.1 questionnaire has been used to evaluate the nine psychosocial risk factors. The emergencies staff quantify the psychosocial factors of working time (19.6 SD 5.7) and autonomy (69.8 SD 23.2) as a higher risk situation compared to the other health care staff with 3.7 SD 4, 7 and 52.1 SD 21.8, respectively (p < 0.05). In addition, the role performance is valued as a lower risk situation by the emergencies staff of primary care (p < 0.05). The workload assessment is the only difference between the emergencies staff of primary care in urban centres (61.5 SD 17.6) and rural (45.2 SD 18.4) (p < 0.05). Women have the highest workload (p < 0.05). It is necessary to apply preventive measures and policies applicable to women who work in emergencies, especially in urban areas to reduce their workload.

Retrospective study on epidemiology of snakebites in Sarpang District, southern Bhutan

Although snake bite envenomation is considered as a medical emergency with significant morbidity and mortality, accurate figures on snakebite envenomation remains scarce. We conducted a retrospective study to evaluate the snakebite epidemiology in Sarpang District located in the subtropical zone of southern Bhutan. In this study, 78 snakebite cases treated in Gelephu Referral Hospital over a period of three years from 2013 to 2015 were evaluated based on the statistical record maintained by the medical administration. Twenty-eight (35.89%) cases developed signs and symptoms of envenomation and the remaining 50 (64.01%) were found to be cases of non-venomous bites. Forty-four males and 34 females were found to be affected by snakebites within the period. While snakebites were observed in all age groups, the large majority (n=51, 65.38%) were in adults aged between 21 and 50 years. Most of the venomous bites (68%) occurred during the monsoon season, particularly between May and August. It was found that adults in the economically productive age group were the ones most affected by poisonous bites. There is an urgent need for development and adoption of snakebite management guidelines and awareness among the vulnerable sections of the population, improvement of medical facilities in referral hospitals and rural health centres, and reduction of the morbidity and mortality associated with snakebites.