Predictors of exclusive breast-feeding in early infancy: a survey report from Phnom Penh, Cambodia.

BACKGROUND: Exclusive breast-feeding (EBF) is recommended in the first 6 months of an infant's life. This study aims to investigate the present status of infant feeding practices and identify factors that affect EBF practices during the first 6 months following infant birth in Phnom Penh, Cambodia. METHODS: A cross-sectional survey with a semistructured questionnaire was given to 312 mothers with children aged 6 to 24 months who visited the immunization clinic in the National Maternal and Child Health Centre in Phnom Penh, Cambodia, from December 2005 to February 2006. RESULTS: Eighty-three percent of mothers fed breast milk exclusively in the first month, whereas only 51.3% continued EBF in the first 6 months. Within 30 minutes after delivery, 39% of mothers began breast-feeding. Results from logistic regression analysis indicate that the lack of a maternal antenatal EBF plan (odds ratio [OR] = 10.01, 95% confidence interval [CI] = 3.68-27.24, p < .001), working mothers (OR = 4.71, 95% CI = 2.77-8.01, p < .001), and lack of paternal attendance at breast-feeding classes (OR = 1.93, 95% CI = 1.13-3.28, p < .05) have independently positive associations with cessation of EBF during the first 6 months of infant life. CONCLUSION: The findings have helped to identify some important factors affecting EBF practices in the study area in Cambodia. The findings revealed that it is important to educate pregnant mothers, probably through exposure to trained midwives and media, so they may recognize the significance of EBF and will develop intention and plan to feed their babies, keeping in mind the benefits it may yield. Paternal involvement in breast-feeding classes may increase their awareness and consequently complement EBF practices. Finally, development of conducive working environments and policies for working mothers should be carefully explored because it could have positive influence in better care and promotion of EBF.

Antenatal care among ethnic populations in Louang Namtha Province, Lao PDR.

One in 33 women in Lao PDR dies due to pregnancy-related causes, which is the highest in Southeast Asia. This study assessed ANC utilization rates and the determinants for these rates; it also explored rural maternal decision-making regarding the place of delivery and immunizations for their children under age five years. A cross-sectional study was carried out in Viengphukha District, Louang Namtha Province, Lao PDR in January 2008. Of 1,005 household representatives, 620 who had children age under five years were interviewed using a semi-structured questionnaire. Nearly one-quarter of mothers (23.4%) had at least one ANC visit during their most recent pregnancy, of which 4.5% had > or = 4 ANC visits. ANC visit rates among lowland and midland mothers were 3.6 and 7.6 times higher than highland mothers, respectively (p < 0.005 and p < 0.001). Mothers with no ANC were more likely to deliver at home (adjusted OR = 18.0; p < 0.0001). Home deliveries were more common among highland than lowland mothers (adjusted OR = 10.5; p < 0.05). Children born to mothers who had no ANC visit were more likely to not complete routine immunization than those who were born to mothers who had ANC visits (adjusted OR = 1.9; p < 0.01). Low ANC utilization rates in Lao PDR were observed among ethnic minority mothers who were less educated. ANC visits enhanced hospital deliveries and child immunizations. The promotion of ANC among women in remote rural communities is needed.

Factors influencing breastfeeding in children less than 2 years of age in Lao PDR.

AIM: This study aimed to investigate the prevalence of, and factors influencing, exclusive breastfeeding (EBF) at 6 months and continued breastfeeding (CBF) at 2 years. METHODS: Between January and February 2007, a cross-sectional study was conducted using a semi-structured questionnaire in 40 villages in the Vientiane capital and the Vientiane province of Lao PDR. A total of 400 mothers with children less than 2 years old were recruited by multistage random sampling. Based on the 1991 World Health Organization Breastfeeding Indicators, children were classified into three groups, 6-23-month-old children for assessing EBF at 6 months, 12-15-month-old children for CBF at 1 year and 20-23-month-old children for CBF at 2 years. RESULTS: The prevalence of EBF at 6 months and CBF at 2 years were 19.4% (n= 283) and 18.6% (n= 43), respectively. Some of the factors influencing EBF at 6 months in a univariate logistic regression model included: location of residence, (OR: 19.19, 95% CI 6.96-57.01), ethnicity (OR: 3.15, 95% CI 1.63-6.08), encouragement of the child's father (OR: 9.03, 95%CI 1.21-67.57) and inter-spousal communication (OR: 5.20, 95% CI 2.34-11.56). A majority of the mothers (75.0%) had watched television advertisements for infant formula from Thailand, and 48.4% reported that they wanted to buy formula milk after having watched them. CONCLUSION: This study showed a low prevalence of EBF at 6 months in the studied area in Lao PDR. Some of the factors that had a strong impact on EBF at 6 months included: location of residence, ethnicity, father's involvement, early breastfeeding plan, Mother's Card in antenatal care and television advertisement. There may be opportunities for government to review a range of policies relating to paternal involvement, antenatal care and formula advertising that could help to improve EBF rate.

Monitoring malaria control in Khammouane province, Laos: an active case detection survey of Plasmodium falciparum malaria using the Paracheck rapid diagnostic test.

In Khammouane province, Laos, over 5000 slide-positive malaria cases were reported at local health facilities in 1997. To combat the spread of malaria, insecticide-treated nets (ITNs) and community health education were provided to the people in this province by the Lao Ministry of Health and the Japan International Cooperation Agency. In order to document the current malaria situation, an active case detection (ACD) survey using rapid diagnostic tests was conducted at 23 sites from June to July, the rainy season, in 2005. A total of 1711 villagers from 403 households participated in the survey. The proportion of positive cases was 0.7% (12/1711) with a range in each village of 0-8.2%. The low infection rate observed in this ACD survey was consistent with the decrease in the number of slide-positive malaria cases at local health facilities (from over 5000 cases to 536 cases), indicating the substantial progress made in malaria control. Although the reduction of malaria cases can be attributed to multiple factors, continued promotion of the proper use of ITNs as well as community-based testing and treatment services, especially in remote areas, may lead to a further reduction of malaria cases in the province.

Physicians' knowledge regarding the recommended anti-tuberculosis prescribed medication regimen: a cross-sectional survey from Lucknow, India.

We conducted a cross-sectional, descriptive survey among 141 medical physicians treating tuberculosis (TB) patients, registered with local chest physicians association in Lucknow District, India. A semi-structured questionnaire was used to evaluate the physicians' knowledge of anti-tuberculosis prescribed medication regimens. Sixty percent of eligible physicians had Revised National Tuberculosis Control Program training, mostly in the public sector. Only two-thirds of physicians could correctly state the recommended TB drugs. Physicians, especially in the private sector, had inadequate knowledge of the approved anti-tuberculosis prescribed medication regimen. This study demonstrates the need for adequate training in both public and private sectors regarding the correct anti-tuberculosis treatment regimens.

Challenges in access to and utilization of reproductive health care in Pakistan.

BACKGROUND: Pakistan's maternal mortality rate is high, and adequate and timely emergency services could prevent most maternal deaths. A woman's right to life-saving services of skilled health care providers in childbirth is undeniable. This paper examines factors restricting women's access to emergency obstetric care services in Pakistan. METHOD: This cross-sectional survey on emergency obstetric care services collected information at the health facility level using UN process indicators. The study enrolled 170 health facilities from nineteen randomly selected districts in Punjab and NWFP. RESULTS: Diverse factors limit women's access to Emergency Obstetric Care (EmOC) services. EmOC services were unavailable in most health facilities surveyed. Staff absenteeism, geographic remoteness, delayed access, and ambulance shortages jeopardize the transferral of seriously ill patients to higher level care facilities. Cultural norms dictate that women should be examined by women doctors, whose dearth makes these services inaccessible. CONCLUSION: Many maternal deaths would be avoidable if EmOC health services were accessible. The geographic obstacles to timely access, poor hospital infrastructure, and high staff absenteeism rates require immediate attention. Health facilities' working hours were inconsistent with the provision of around-the-clock essential services, depriving and endangering the lives of many in need. It is imperative to increase skilled female workers capable of managing EmOC problems through proper incentives. A focused approach at local levels through proper supervision, motivation, and management would unquestionably save women's lives.

The successes and challenges of the IMCI training course in Lao Pdr.

The purpose of this article is to explore whether the style and content of the IMCI algorithm and delivery of the training course match the needs and capacities of the Lao health workers. Unlike other IMCI studies that rely on external indicators, this study uses an open-ended qualitative approach to focus on the perspectives of the trainees through observation and trainee interviews. The findings showed that IMCI is a practical tool for health workers, and the interactive course is an effective way to teach it. Health workers responded that learning the algorithm was challenging due to the novel format and guidelines, but easy due to its clarity and straightforwardness. The main problems concerned the adaptability of guidelines and shortage of time. Incorporating in-depth clinical explanations and inviting facilitators with medical knowledge and experience using IMCI may be key to resolving such issues.

Accurate record keeping in referral hospitals in Pakistan's north west frontier province and Punjab: a crucial step needed to improve maternal health.

OBJECTIVE: To assess record keeping practices in referral hospitals in the North West Frontier Province (NWFP) and Punjab province, focusing specifically on United Nation's Emergency Obstetric Care (UN EmOC) indicators of maternal morbidity and mortality. METHODS: This cross-sectional survey collected information at the health facility level, using UN process indicators to assess EmOC services. The study enrolled 170 health facilities from 19 randomly selected districts in Punjab and NWFP. RESULTS: The study found poor record keeping practices in the health care facilities of both provinces. A few facilities had no records at all; information on obstetric complications was inconsistent. Many facilities' records were marked by duplications, inaccuracies, and data was deficient. CONCLUSION: Health policies and planning in any country depend heavily on having correct and timely information on health parameters. In Pakistan, many recording and data collection problems can be solved by having well-designed and accurately maintained data registers. Proper and regular supervision and staff training are invaluable components of data collection. Efforts to improve record keeping may provide a low-cost, low-technology way to document progress towards improving maternal health.

Modern medicine and indigenous health beliefs: malaria control alongside "Sadsana-phee" (animist belief system) in Lao PDR.

The major religion in Lao PDR is Buddhism, but many ethnic groups in rural Lao PDR hold an animist belief system called "Sadsana-pee". At the same time, the Bourapar District study site in Khammouane Province, Lao PDR is at high risk of malaria infection. Due to their belief in traditional ways of healing, the promotion of malaria prevention and treatment with modern medicine was not always welcomed by the villagers. Based on the results of questionnaire interviews with 240 heads of households from February to March of 2003, the effect of local beliefs on malaria control activities was discussed. Despite widely available western medicine and widely conducted health education, some people still believe that evil spirits cause malaria and rely on traditional medicine and/or religious ceremonies for treatment. Based on our findings, we recommend that future education and malaria control programs be revised and made sensitive to those people holding indigenous beliefs.

Prevalence of asthma, rhinitis, and eczema among children in Vientiane city, Lao PDR.

An International Study of Asthma and Allergy in Childhood (ISAAC) revealed a wide range of prevalences of childhood asthma in the world. Lao PDR had no such epidemiological data yet. This study aimed to investigate the epidemiology of asthma, rhinitis, and eczema in children in the country. A cross-sectional study was conducted in Vientiane City, the capital of Lao PDR, in 1997 using the ISAAC questionnaire. From three primary schools and one high school, 395 children, age 6-7 years, and 468 children, age 13-14 years, were chosen. The prevalence of asthma for children aged 13-14 years in Lao PDR was 25.6%, which ranks the highest in international asthma prevalence. The prevalence in allergic-rhinoconjunctivitis of children was 24.4% and atopic eczema was 7.1%. Contrary to generally accepted risk factors, there were no associations revealed between asthma prevalence and smoking of family members (especially mothers), intake of fish/meat, and male gender.

Quantity and distribution of continuing professional education opportunities among healthcare workers in Ghana.

BACKGROUND: Despite their importance, continuing professional education opportunities have been rarely addressed in literature. This study explains how continuing professional education opportunities among the healthcare workers in Ghana are distributed. METHOD: A census was conducted using a self-administered questionnaire (N = 6,696). Three focus group discussions with a total of 23 healthcare workers were undertaken. RESULTS: The study found that the quantities of continuing professional education opportunities were unequally distributed. The total continuing professional education opportunities were greater than the target of the Ministry of Health but fewer than healthcare workers' demand. Type of occupational group was the major determinant of continuing professional education opportunities. CONCLUSION: To ensure homogeneously appropriate quality of services, continuing professional education opportunities should be equally distributed.

Emergency obstetric care availability, accessibility and utilization in eight districts in Pakistan's North West Frontier Province.

BACKGROUND: Reducing maternal mortality is a critical issue in Pakistan. Do public health care centers in Pakistan's North West Frontier Province (NWFP) comply with minimum UN recommendations for availability, use, and quality of basic and comprehensive Emergency Obstetric Care (EmOC) as measured by UN process indicators? METHODS: All public health facilities providing EmOC (n = 50) in 30% of districts in NWFP province (n = 8 districts) sampled randomly in September 2003 were included in a cross-sectional study. Data came from health facility records. RESULTS: Almost all indicators were below minimum recommended UN levels. The number of facilities providing basic EmOC services was much too low to be called providing comprehensive coverage. A low percentage of births took place in hospital and few women with complications reached EmOC facilities. Caesarean section was either underutilized or unavailable. The case fatality rate was low, perhaps due to poor record-keeping. CONCLUSION: The findings of this first needs assessment in NWFP province can serve as a benchmark for monitoring future progress. In resource-poor countries like Pakistan, it is important to upgrade existing facilities, giving special emphasis to facilities that provide basic EmOC services, since many problems can be resolved at the most basic level. Health policy makers and planners need to take immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas, enhance staff skills through training, upgrade management and supervision, ensure medical supply availability, mandate proper record-keeping, and observe progress by monitoring process indicators regularly.

Hidden reality on the introduction of auto-disable syringes in developing countries.

With the growing concerns about the risk of unsafe injections (e.g. unsterilized injection practices), WHO, UNICEF and UNFPA decided to introduce the auto-disable (AD) syringe for immunization in the world. The AD syringe is designed to be automatically locked after a single use, hence no chance of reuse. Consequently, the risk of infection can be reduced for the recipient. On the other hand, the management of increased medical waste is becoming difficult, as the waste volume of AD syringes would be 200 times as much as those of sterilizable syringes. The used and improperly disposed AD syringes could be a huge source of blood-borne infections and environmental pollution at the community level. This study attempted to explore the present situation with regard to the introduction of AD syringes for immunization in Lao PDR. We conclude that reviewing the present 'safe injection' policy is urgently required in Lao PDR, as well as in other developing countries where the disposal system for medical wastes is not yet well established.

Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale.

INTRODUCTION: Pakistan's 2005 earthquake claimed almost 87,000 lives and displaced millions. The present study sought to assess PTSD prevalence among earthquake survivors, to evaluate its determinants, and to identify protective factors that suggest future interventions in the aftermath of disasters. METHODS: In a cross-sectional survey, three districts were selected based on their proximity to the epicenter and the presence, accessibility, and security of refugees, 300 earthquake survivors were enrolled. RESULTS: Analysis revealed that after 30months, PTSD prevalence was high. Being female, older, unmarried, head of the family, and currently unemployed and having low income and living in temporary housing confer higher risks of PTSD. Having a high social capital and religious inclination seem to have protective, buffer effect and increase resilience against PTSD. CONCLUSION: This is the first post-quake study in Pakistan that has utilized, adapted and validated Davidson Trauma Scale in the local context. Results imply the significance of continued psychological support, of drawing on resilience factors in PTSD management. Implications and directions for future research are discussed.

Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia.

BACKGROUND: Needlestick and sharps injuries (NSSIs) are one of the major risk factors for blood-borne infections at healthcare facilities. This study examines the current situation of NSSIs among health care workers at public tertiary hospitals in an urban community in Mongolia and explores strategies for the prevention of these injuries. FINDINGS: A survey of 621 health care workers was undertaken in two public tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-structured and self-administered questionnaire was distributed to study injection practices and the occurrence of NSSIs. A multiple logistic regression analysis was performed to investigate factors associated with experiencing NSSIs. Among the 435 healthcare workers who returned a completed questionnaire, the incidence of NSSIs during the previous 3 months was 38.4%. Health care workers were more likely to report NSSIs if they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95% confidence interval, CI: 1.31-4.66) and administered more than 10 injections per day (OR: 4.76; 95% CI: 1.97-11.49). The likelihood of self-reporting NSSIs significantly decreased if health care workers adhered to universal precautions (OR: 0.34; 95% CI: 0.17-0.68). CONCLUSIONS: NSSIs are a common public health problem at public tertiary hospitals in Mongolia. The promotion of adequate working conditions, elimination of excessive injection use, and adherence to universal precautions will be important for the future control of potential infections with blood-borne pathogens due to occupational exposures to sharps in this setting.

Malnutrition among children in rural Malawian fish-farming households.

To estimate the impact of fish farming operated at household level on nutritional status among children 6-59 months of age, a cross-sectional study was conducted in Zomba district, Malawi. Anthropometric measurements of 66 children in each type of household (fish-farming and non-fish-farming households) and structured interviews with their parents were undertaken. A total of 21 background variables were employed and examined using bivariate and multivariate analyses. Overall, a lower prevalence of malnutrition was detected among the children in fish-farming households than those in non-fish-farming households in all the malnutrition indicators, i.e. stunting, underweight and wasting. In particular, a significantly lower prevalence was detected among the children in fish-farming households than those in non-fish-farming households in both severe (P=0.045) and global underweight (P=0.042). 'Higher proportion of income from fish farming to total income', 'more frequent intake of oil and fats other than never/seldom' and 'breastfeeding practice for the appropriate duration' are the protective factors against being underweight. Household fish farming may have indirectly contributed to lower prevalence of underweight through increasing frequency of intake of oil and fats by strengthening households' purchasing power. The study supports 12 months as the threshold for appropriate breastfeeding duration.

Scaling up interventions to eliminate neonatal tetanus: factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane, Lao PDR.

The Lao People's Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.

Hospital medical waste management in Shandong Province, China.

Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed(-1) day(-1) in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.

Emergency obstetric care in Punjab, Pakistan: improvement needed.

INTRODUCTION: This paper describes an approach to maternal mortality reduction in Pakistan that uses UN emergency obstetric care (EmOC) process indicators to examine if public health care centres in Pakistan's Punjab province comply with minimum recommendations for basic and comprehensive services. METHODS: In a cross sectional study in September 2003, through random sampling at area and health-facility levels from 30% of districts in Punjab province (n = 11/34 districts), all public health facilities providing EmOC were included (n = 120). Facility data were used for analysis. RESULTS: No district in Punjab met the minimum standards laid down by the UN for providing EmOC services. The number of facilities providing basic and comprehensive EmOC services fell far short of recommended levels. Only 4.7% of women with complications attended hospitals. Caesarean section was carried out in only 0.4% of births. The case fatality rate was hard to accurately calculate due to poor record keeping and data quality. CONCLUSION: The study may be taken as a baseline for developing and improving the standards of services in Punjab province. It is vital to upgrade existing basic EmOC facilities and to ensure that staff skills be improved, facilities be better equipped in critical areas, and record keeping be improved. Hence to reduce maternal mortality, facilities for EmOC must exist, be accessible, offer quality services, and be utilized by patients with complications.

The reality of health information systems: challenges for standardization.

Health information systems (HISs) serve as an indispensable foundation for developing health policy and strategies and improving delivery of routine health services in an evidence-based manner. In developing countries, HISs are not adequately functioning in spite of their important role such as monitoring tools for the progress of the Millennium Development Goals. This paper attempts to classify the HISs into four types according to their data sources. Information requirement by the diseases-specific funds (e.g. Global Fund to Fight AIDS, Tuberculosis and Malaria) and projects implemented by development agencies increase the workloads of health professionals at facility level and subsequently compromise data quality. For the data quality assurance and comparability of data across countries overtime of major health indicators, standardization of HISs are the urgent task.