Public Health

Patient’s satisfaction is a useful measure to provide an indicator of quality in healthcare services. Concern over the quality of healthcare services in Bangladesh has led to loss of faith in healthcare providers, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns—all of these service failures are reported frequently in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with healthcare service providers and healthcare itself.

Background: Depression is a very important part of global mental health concerns. Many of the studies on correlates of depression stopped short of finding the predictors. Predictive models will empower preventative efforts by healthcare providers and policy makers. The purpose of this study was to determine the factors predicting depressive symptoms among a population of older men and women in rural South Africa. Methods: Data were obtained from “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) in the INDEPTH Health and Demographic Surveillance System (HDSS) site of Agincourt” in rural Mpumalanga province, South Africa. Previously validated short-version Center for Epidemiologic Studies Depression Scale (CES-D 8) was used to assess for depressive symptoms. Multivariable logistic regression model with stepwise selection, and receiver operating curve were used to examine the predictors of depression. Results: Of the 4027 participants included in this study, 743 (18.5%) met the criterion for depression (CES-D 8 score ≥3). Older age (OR 1.025, CI 1.016-1.034), diabetes (OR 1.467, CI 1.152-1.868), and alcohol consumption (OR 1.536, CI 1.261-1.872) predicted depression. Being male (OR 0.734, CI 0.588-0.915) and homemaker rather than not working (OR 0.513, CI 0.372-0.707) were protective. Compared to those who were married, depressive symptoms were significantly higher among the separated/divorced (OR 1.372, CI 1.027-1.834) and the widowed (OR 1.468, CI 1.172-1.839). Conclusions: It is possible to predict the development of depression in this community, and findings are generalizable to other communities and countries. Healthcare workers and policy makers should use the findings for preventative care and policies.

Caesarean section (CS) is lifesaving medical procedure that is able to avert both maternal and neonatal mortality. However, across the globe an estimated 3.2 million necessary CSs do not happen in low income countries and an estimate of 6.2 million unnecessary CSs happen in middle and high income countries. The overuse and underuse of this procedure driven by both the supply-side (such as resources within the health system, healthcare policy and strategies, health financing systems and perceptions of the healthcare professional) and demand-side (such as socio-economic status, population preference and perceptions and trust in health system) determinants. There are stark inequities in CS rates between and within regions and countries. Many regions across the globe (Eastern Asia, Northern Europe, Central America, Southern America, Northern America and Oceania) have over double recommended optimal rates, whereas several African regions (Eastern, Middle and Western) have dangerously low rates. Both of these have detrimental impacts on maternal and neonatal outcomes. There is a need now for health policy and decision makers at both national and facility level to try and optimize the CS rates through facilitating strategies that promote positive human relations and encourage standardized evidence based care.

Background: No prior studies have assessed the relationship of school-sites with children’s fitness, nor evaluated how it is influenced by types of built environments surrounding school-sites. Purpose: To create a typology of school-sites and assess their associations, with school-level cardiorespiratory fitness (PACER score), as well as 34 environmental measures, reflecting food retailers and parks. Methods: PACER scores (#laps) were obtained on 20,900 children, 5-18 years-old, attending 103 rural and urban public schools in Wisconsin 2009-2010. Scores were aggregated at the school-level (mean 25.2±10.5). School-site typology reflects walkability context and parcel size. Schools were classified as: Neighborhood-School, Neighborhood-Campus, Neighborhood-Suburban, or Campus-School. Geospatial and linear regression were performed , overall and by sex and age strata, using a 1600-meter circular buffer around each school. Associations with school-level-PACER score were assessed for school types; density of unhealthy and healthier food retailers; and types of parks. Results: Campus-Schools predict a school average-PACER 7 laps significantly higher than Neighborhood-schools. ‘Neighborhood-Campus’ showed the lowest PACER for males and 11-13 years-old (10 and 12 laps lower). Negatively correlated with average-PACER were, unhealthy convenience stores for both sex, large parks for females. More fast-casual restaurants predict higher average-PACER. Schools with more students predict higher average-PACER for males and 6-10 years-old. Conclusion: Among Wisconsin schools, school-site and its context are associated with children’s physical fitness, suggesting that school-siting should include a health benefit analyses in the process. This study demonstrates the utility of school-level PACER scores and suggests further study of the mechanisms by which children’s fitness is influenced by food retailers around school zones.

Introduction: Bedbug infestations have become a serious problem in housing dueto their crawling and blood sucking activities. Objective: This study was aimed to assess the infestation status and public health importance of bed bug infestation in low income communities at household level. Methods: A community based cross-sectional study was conducted between January and February, 2018 on 721 housuholds in Arba Minch zuria Woreda, Southern Ethiopia with random sampling technique. Data collection was undertaken on knowledge and attitude about bed bug and bedbug infestation health impacts and factors for the infestation and control practices used were collected with well prepared questionnaire and standard observational check. Results: From all inspected materials, 97% infestation were on wall and sleeping and mosquito bed nets. The left materials relatively infested less were arm chair (2.76%) and other materials (0.89%) found in the house of the participants. About 31% and 15% participants reported bed bug infestation prohibited from using mosquito nets and cause thyphoid respectively. The left 55 % of participants reported the infestation causes wounds, itching, lossing rest and skin lesion. 98.1% of the participants have a knowledge about bed bug, blood sucking insects and 44% of respondents believed in insecticide nets increases the infestation. 72.5% household are using together hot water (42.28%) and ajjacks with water (30.2%) followed by 18.8% chemicals to control infestation. Omo soap, sun lights and plants were optional mechanisms of infestation controls. Conclusion: Bedbugs resurgences and its related factors are being considered as public health problem in Ethiopia. More researches focusing on bed bug biology and epidemiology are required establish a new prevention, treatment, control options and public health response.

Temporomandibular Disorder (TMD) is a clinical syndrome that mainly affects the masticatory muscles and temporomandibular joints (TMJ). The manual palpation is the most used clinical method to evaluate the muscle pain and is considered an important part of the clinical examination. The pressure algometry is used to verify the initial threshold of myofascial pain perception in the temporomandibular disorder. The purpose of this research was to evaluate the pain threshold change in patients with muscle-type TMD before and after the conservative treatment. Twenty seven volunteers were screened according to the Research Diagnostic Criteria (RDC/TMD), and 14 had muscle TMD and 13 with absence of TMD (control group). Measurements were taken with the pressure algometer in every patient in temporal and masseter muscles in order to quantify the response to the patient painful stimulus. After the proposed treatment the patient was scheduled to return in 7,14, 28 and 56 days. Therefore, it resulted in 18 patients for the study. The algometer comparison between the groups treated before and after the care, showed an initial value (in KgF) of 0.827 ± 0.405 and final of 1.416 ± 0.745, p

This paper accesses the quality of the Acute Flaccid Paralysis (AFP) surveillance system in Edo state using the May/June 2017 Rapid Surveillance Assessment tool for reviewing existing surveillance systems. This was a descriptive cross-sectional study involving the Disease surveillance and notification officers (DSNOs), and their assistants (ADSNOs) in all 18 Local Government Areas (LGAs). All the surveillance officers were 100% knowledgeable on the AFP case definition. About, 94% of the ADSNOs knew how the AFP stool specimens were transported. Only 75% and 50% of the DSNOs and ADSNOs respectively could mention all seven AFP differential diagnosis stated in the AFP surveillance guidelines. Active surveillance was conducted by 89% of the DSNOs in their respective LGAs within the last six months prior to this study. Only 22% of the ADSNOs were actively involved in surveillance activities. Records of documentation of AFP surveillance activities dating as far back as three years were readily available at the offices of 90% of the DSNOs and with the state epidemiologist. Edo state has shown attributes of a quality surveillance system in terms of knowledge, AFP surveillance and documentation. We however encourage a surveillance system that is more inclusive with active participation from the ADSNOs.

Background: Pre-eclampsia is one of the causes of maternal morbidity and mortality throughout the world. It is common problem in developing countries. This study was aimed to assess the maternal outcomes of severe pre-eclampsia among pregnant women admitedand managed at at Hidar 11 Hospital in 2018. Methods: A cross-sectional study was conducted among preeclamptic women who were admitted to maternity ward of at Hidar 11 Hospital in a four year period from JAN 1/ 2014 – Decem 31/ 2018. All laboring mothers that are admitted and managed at hidar 11 hospitals was a source population retrieved by review of clinical records and then, the data was collected from April 1-30 2018. Daily completeness of the questionnaire was cross checked by principal investigator for data quality control using prepared checklist after a pretest given. Data regarding patient characteristics and treatment outcome (eg. maternal death, maternal complication, hospital stay) were collected. Data was collected using data collection format from patient medical charts. data was cleaned coded entered and analyzed using SPSS version 20. Descriptive statistics and logistic regression were used. All the statistical tests were significant at P-value < 0.05,Besides odd ratio 95%CI was used. Results: A total of 318 mothers’ medical charts were reviewed. One hundred sixty five (82.5%) pregnant women were diagnosed with severe preeclampsia. About 98(30.8%) of the women developed complications. The most common maternal complication was HELLP syndrome Mothers with gestational age less than 34weeks were 6.8 times more likely to develop complication [AOR=6.8, 95% CI = 1.974-24.026].similarly primigravida 4 times more likely to develop complication[AOR=4.934 CI =2.281-10.675 ]. Mothers with antipartum preeclampsia were 6.6 times more likely to have prolonged hospital stay [AOR=6.611 ,95% CI=2.749-15.898]. Conclusion: The commonly seen poor treatment outcomes in preclamptic mothers were magnesium sulphate toxicity, prolonged hospital stay and development of complications. Preeclampsia...

Background: Healthcare workers are exposed to work related stress in the course of their activities. We conducted this study to determine the prevalence of work-related stress and search for its associated factors among healthcare workers assigned to the emergency medical services of public hospitals in Douala. Methods: The cross-sectional and analytical study was carried out from March 27th to June 30th, 2017 in 8 public hospitals in Douala. The sampling method was non-random, consisting of consecutive recruitment of volunteer healthcare staff working in the emergency departments of public hospitals who provided the framework for the study. The level of stress was measured using the French version of KARASEK’s psychometric scale. The analysis was performed with SPSS 20.0 software. The study was authorized and obtained an clearance was granted. Results: The sample consists of 51 men (33.55%) and 101 women (66.44%). The average age is 34.6 ± 5.4 years. Nurses (54.6%) and healthcare staff aged 30 to 39 years (61.2%) predominates in the sample. Day / night shift work is the main form of work done by ¾ staff (75.6%). The prevalence of stress is 78.9% and the associated risk factors are the following: belonging to a 4th category hospital (p = 0.008), medical professions (p = 0.001), nurses (p = 0.0002), work experience of less than 10 years (p = 0.04) and exclusive night shifts (p = 0.02). Conclusion: Continuous improvement of the working conditions must be implemented inside the various facilities to mitigate the consequences of work related stress among the healthcare workers.

Occupational exposure to blood and body fluids is a serious concern for health care personnel (HCP), and posed a serious risk for the transmission of infectious pathogens. The aim of this study was to investigate occupational exposures of HCP at first level hospitals in Meme Division, Cameroon. We sampled 190 HCP working in 3 first level referral hospitals in Meme division in Cameroon using a structured questionnaire with a participation rate of 94.06 %. Descriptive statistics and multivariate analysis using logistic regression were performed. Of the 190 HCP who participated in the study, 77 (40.53 %) indicated having at least an encounter with exposure with blood and body fluids within the past 12 months. The physicians (78.57%) and the nurses (40.54%) were the most exposed categories of HCP. Working for long hours, lack of continuous training on infection prevention, 7-10 years working experience, dissatisfaction with current jobs, recapping needles after used were significantly associated with exposure and transmission risk to blood and body fluids among HCP. There was a high level of exposure to blood and body fluids among HCP at the first level referral hospitals in Meme division in Cameroon. Programs targeting the implementation of surveillance systems for training, registering, reporting, provision of basic personal protective equipment and management of occupational exposures in health care settings should be prioritised.