Search results for: medical and health sciences
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11487

Search results for: medical and health sciences

10377 Implementing a Structured, yet Flexible Tool for Critical Information Handover

Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

Abstract:

An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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10376 Current Global Education Trends: Issues and Challenges of Physical and Health Education Teaching and Learning in Nigerian Schools

Authors: Bichi Muktar Sani

Abstract:

The philosophy of Physical and Health Education is to develop academic and professional competency which will enable individuals earn a living and render unique services to the society and also provide good basis of knowledge and experience that characterize an educated and fully developed person through physical activities. With the increase of sedentary activities such as watching television, playing videogames, increased computer technology, automation and reduction of high school Physical and Health Education schedules, young people are most likely to become overweight, and less fit. Physical Education is a systematic instruction in sports, training, practice, gymnastics, exercises, and hygiene given as part of a school or college program. Physical and Health Education is the study, practice, and appreciation of the art and science of human movement. Physical and Health Education is course in the curricula that utilizes the learning in the cognitive, affective, and psychomotor domains in a lay or movement exploration setting. The paper made some recommendations on the way forward.

Keywords: issues, challenges, physical education, school

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10375 Design of Circular Patch Antenna in Terahertz Band for Medical Applications

Authors: Moulfi Bouchra, Ferouani Souheyla, Ziani Kerarti Djalal, Moulessehoul Wassila

Abstract:

The wireless body network (WBAN) is the most interesting network these days and especially with the appearance of contagious illnesses such as covid 19, which require surveillance in the house. In this article, we have designed a circular microstrip antenna. Gold is the material used respectively for the patch and the ground plane and Gallium (εr=12.94) is chosen as the dielectric substrate. The dimensions of the antenna are 82.10*62.84 μm2 operating at a frequency of 3.85 THz. The proposed, designed antenna has a return loss of -46.046 dB and a gain of 3.74 dBi, and it can measure various physiological parameters and sensors that help in the overall monitoring of an individual's health condition.

Keywords: circular patch antenna, Terahertz transmission, WBAN applications, real-time monitoring

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10374 Possibilities and Limits for the Development of Care in Primary Health Care in Brazil

Authors: Ivonete Teresinha Schulter Buss Heidemann, Michelle Kuntz Durand, Aline Megumi Arakawa-Belaunde, Sandra Mara Corrêa, Leandro Martins Costa Do Araujo, Kamila Soares Maciel

Abstract:

Primary Health Care is defined as the level of a system of services that enables the achievement of answers to health needs. This level of care produces services and actions of attention to the person in the life cycle and in their health conditions or diseases. Primary Health Care refers to a conception of care model and organization of the health system that in Brazil seeks to reorganize the principles of the Unified Health System. This system is based on the principle of health as a citizen's right and duty of the State. Primary health care has family health as a priority strategy for its organization according to the precepts of the Unified Health System, structured in the logic of new sectoral practices, associating clinical work and health promotion. Thus, this study seeks to know the possibilities and limits of the care developed by professionals working in Primary Health Care. It was conducted by a qualitative approach of the participant action type, based on Paulo Freire's Research Itinerary, which corresponds to three moments: Thematic Investigation; Encoding and Decoding; and, Critical Unveiling. The themes were investigated in a health unit with the development of a culture circle with 20 professionals, from a municipality in southern Brazil, in the first half of 2021. The participants revealed as possibilities the involvement, bonding and strengthening of the interpersonal relationships of the professionals who work in the context of primary care. Promoting welcoming in primary care has favoured care and teamwork, as well as improved access. They also highlighted that care planning, the use of technologies in the process of communication and the orientation of the population enhances the levels of problem-solving capacity and the organization of services. As limits, the lack of professional recognition and the scarce material and human resources were revealed, conditions that generate tensions for health care. The reduction in the number of professionals and the low salary are pointed out as elements that boost the motivation of the health team for the development of the work. The participants revealed that due to COVID-19, the flow of care had as a priority the pandemic situation, which affected health care in primary care, and prevention and health promotion actions were canceled. The study demonstrated that empowerment and professional involvement are fundamental to promoting comprehensive and problem-solving care. However, limits of the teams are observed when exercising their activities, these are related to the lack of human and material resources, and the expansion of public health policies is urgent.

Keywords: health promotion, primary health care, health professionals, welcoming.

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10373 Correlation between Sleeping Disturbance and Academic Achievement in University Female Students

Authors: Amel Fayed, Shaden AlSubaih, Nouf Al-Qahtani, Asmaa Gosty, Asma Aljuhaimi

Abstract:

Introduction: Sleep difficulties are vastly predominant among adults and affect different aspects of their life. Many literatures found out that females are more liable to suffer from sleeping problems. College students are typical example of people dealing with daily pressure and stress to fulfill the daily tasks and responsibilities. In addition to their ultimate goal of achieving excellent academic records which require their full concentration and effort. Consequently, many of them start complaining of sleep deprivations which can undesirably affect their academic achievements. This study was aiming to investigate how prevalent is sleeping disorders among different colleges in the university and its relation their academic achievements. Methods: A cross-sectional study of female university students at Princess Norah Bint Abdulrahman University using self-administered questionnaire was conducted. Insomnia Severity Index (ISI) was used to assess different grades of insomnia. Students were requested to answer the questions evaluating their sleeping habits over the last two weeks. Participants reported their latest Grade Point Average (GPA). According to ISI, insomnia severity is reported as ‘No clinically significant’, ‘Subthreshold ‘,’ Clinical moderate insomnia’ and ‘Clinical severe’. Results: In the current study, 228 students participated; 172(75.4%) from medical colleges and 56 (24.6%) from non-medical colleges. About 80% of them claimed to have never taken any medications to help them sleep while only three students confirmed their regular use of sleep-inducing medications. About 16% of the students drink milk or other hot drinks to help them fall asleep. None of the students was suspected of having obstructive sleep apnea or apparent psychiatric disorder. According to ISI, 182 (79.8%) students suffered from subthreshold insomnia, 37 (16.2%) had clinical insomnia (moderate severity) and 9 (3.9%) of students had sleeping problems of non-clinically significance level. However, none of students was found to have severe clinical insomnia. Clinical moderate insomnia was reported in 15.1% of medical students and 19.6% of non-medical students. Moreover, about 82% of medical students suffered from subthreshold insomnia compared to 73.2% of non-medical students. This difference was not statistically significant (P=0.24). About 63% of medical students and 48% of non-medical students believed that high percentage of their colleagues are suffering from insomnias (p-value 0.08) The association between GPA and insomnia revealed that; 19.5% of low GPA group compared to 9.3% of high GPA group had clinical moderate insomnia. This association was not statistically significant (p=0.15). The correlation between the GPA and the ISI score was negative but not conclusive (r=-0.08, p-value = 0.29). More than 92% of all students agreed that sleeping problems affect their academic achievement to varying degrees. Conclusion: our results suggest that insomnia is commonly prevalent among female university students and might affect the students’ achievement. This study provides preliminary data about the quality of sleep among medical and non-medical university students which may be used to promote the healthy sleeping habits among female students.

Keywords: academic achievement, females, insomnia, university student

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10372 Health Literacy and Knowledge Related to Tuberculosis among Outpatients at a Referral Hospital in Lima, Peru

Authors: Rosalina Penaloza, Joanna Navarro, Pauline Jolly, Anna Junkins, Carlos Seas, Larissa Otero

Abstract:

Background: Tuberculosis (TB) case detection in Peru relies on passive case finding. This strategy relies on the assumption that the community is aware that a persistent cough is a possible symptom of TB and that formal health care needs to be sought. Despite its importance, health knowledge specific to TB is underexplored in Peru. This study aimed to assess health literacy and level of TB knowledge among outpatients attending a referral hospital in Lima, Peru. The goal was to ascertain knowledge gaps in key areas relating to TB, to identify and prioritize subgroups for intervention, and to provide insight for policy and community interventions considering health literacy. Methods: An observational cross-sectional study was conducted using a survey to measure sociodemographic factors, tuberculosis knowledge, and health literacy. Bivariate and Multivariate logistic regression was performed to study the associations between variables and to account for potential confounders. The study was conducted at Hospital Cayetano Heredia in Lima, Peru from June – August 2017. Results: 272 participants were included in the analysis. 57.7% knew someone who had had TB before, 9% had had TB in the past. Two weeks a cough was correctly identified as a symptom that could be TB by 69.1%. High TB knowledge was found among 149 (54.8%) participants. High health literacy was found among 193 (71.0%) participants. Health literacy and TB knowledge were not significantly associated (OR 0.9 (95%CI 0.5-1.5)). After controlling for sex, age, district, education, health insurance, frequency of hospital visits and previous TB diagnosis: High TB knowledge was associated with knowing someone with TB (aOR 2.7 (95%CI 1.6-4.7)) and being a public transport driver, (aOR 0.2 (95%CI 0.05-0.9)). Not being poor was the single factor associated with high health literacy (aOR 3.8 (95%CI 1.6-8.9)). Conclusions: TB knowledge was fair, though 30% did not know the most important symptom of TB. Tailoring educational strategies to risk groups may enhance passive case detection especially amongst transport workers in Lima, Peru.

Keywords: health literacy, Peru, tuberculosis, tuberculosis knowledge

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10371 Congenital Sublingual Dermoid Cyst with Cutaneous Fistula

Authors: Rafael Ricieri, Rogerio Barros, Francisco Clovis

Abstract:

Objective– The Objective of this is study is to report a rare case of dermoid cyst, with a sublingual location and cutaneous fistula in a 4 year-old child.Methods: This study is a case report. The main study instrument was the medical record and the radiological and intraoperative image bank. Results: Infants with congenital cervical lesions eventually need tomography for diagnostic elucidation, and health services should be structured to perform sedation and thin tomographic sections in order to reduce morbidity.

Keywords: congenital, sublingual dermoid cyst, fistula, pediatric surgery, head and kneck surgery

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10370 Comparative Analysis of Patent Protection between Health System and Enterprises in Shanghai, China

Authors: Na Li, Yunwei Zhang, Yuhong Niu

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The study discussed the patent protections of health system and enterprises in Shanghai. The comparisons of technical distribution and scopes of patent protections between Shanghai health system and enterprises were used by the methods of IPC classification, co-words analysis and visual social network. Results reflected a decreasing order within IPC A61 area, namely A61B, A61K, A61M, and A61F. A61B required to be further investigated. The highest authorized patents A61B17 of A61B of IPC A61 area was found. Within A61B17, fracture fixation, ligament reconstruction, cardiac surgery, and biopsy detection were regarded as common concerned fields by Shanghai health system and enterprises. However, compared with cardiac closure which Shanghai enterprises paid attention to, Shanghai health system was more inclined to blockages and hemostatic tools. The results also revealed that the scopes of patent protections of Shanghai enterprises were relatively centralized. Shanghai enterprises had a series of comprehensive strategies for protecting core patents. In contrast, Shanghai health system was considered to be lack of strategic patent protections for core patents.

Keywords: co-words analysis, IPC classification, patent protection, technical distribution

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10369 An Investigation of the Compliance of Kermanian College Students' Diet with Who/Fao Nutrition Targets

Authors: Farideh Doostan, Sahar Mohseni Taklloo, Mohammad Nosrati

Abstract:

Chronic diseases are non-communicable and largely preventable by lifestyle changes including healthy diet consumption. They are the most common cause of death in the world and projected to increase by 15% globally between 2010 and 2020.The hazardous effects of behavioral and dietary risk factors on chronic disease have been established in prospective cohort studies and randomized trials. Because of some changes occur in college students’ lifestyle, assessment of dietary risk factors is important in these populations. Objective: This research was the first study that conducted to evaluate dietary intakes of Kermanian college students with WHO/FAO nutritional objectives. Material and Methods: In this descriptive cross-sectional study, 229 healthy college students of health faculty in Kerman University of Medical Sciences that do not intake any medical drugs were recruited using multistage sampling in 2013.Usual dietary intake was collected using a valid Food Frequency Questionnaire (FFQ) and diet quality was calculated based on WHO nutrient goals. To analysis of data between two groups, independent sample t. test and man whitney were applied. Results: Two hundred and twenty-nine college students; 151 females (65.9%) and 78 males (34.1%), the mean age of 21.9 years were studied. The mean of the Body Mass Index (Kg/m2) and Waist Circumference (cm) in males were 22.34 ±3.52 and 80.76±11.16 and in females were 21.19±2.62 and 73.67±7.65 respectively. Mean of daily cholesterol intake in males was significantly more than females (305±101 VS 268±98; P=0.008) and more than WHO/FAO recommendation (less than 300 mg/day). The mean of daily sodium intake in men and women were 10.4±1 and 10.9±5.3 respectively. These amounts were more than WHO/FAO recommendation (less than 2g/day). In addition, women were consumed fruit and vegetables more than men (839±336 VS 638±281; p ‹ 0.001) and these amounts were more than WHO/FAO recommendation (more than 400g/day) in both groups. Other intake indices were in the range of WHO/FAO recommendations, So that Percent of calories intake from total fat, saturated fatty acids, polyunsaturated fatty acids and added sugar were in compliance with WHO/FAO recommendations. Conclusion: Cholesterol intake in men and sodium intake in all participants were more than WHO/FAO recommendation. These dietary components are the most important causes of cardiovascular disease (one of the main causes of death in our population). These results indicated that proper nutritional education and interventions are needed in this population.

Keywords: college students, food intake, WHO /FAO nutrient intake goals, Kerman

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10368 Quality of Life of Patients on Oral Antiplatelet Therapy in Outpatient Cardiac Department Dr. Hasan Sadikin Central General Hospital Bandung

Authors: Andhiani Sharfina Arnellya, Mochammad Indra Permana, Dika Pramita Destiani, Ellin Febrina

Abstract:

Health Research Data, Ministry of Health of Indonesia in 2007, showed coronary heart disease (CHD) or coronary artery disease (CAD) was the third leading cause of death in Indonesia after hypertension and stroke with 7.2% incidence rate. Antiplatelet is one of the important therapy in management of patients with CHD. In addition to therapeutic effect on patients, quality of life is one aspect of another assessment to see the success of antiplatelet therapy. The purpose of this study was to determine the quality of life of patients on oral antiplatelet therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This research is a cross sectional by collecting data through quality of life questionnaire of patients which performed prospectively as primary data and secondary data from medical record of patients. The results of this study showed that 54.3% of patients had a good quality of life, 45% had a moderate quality of life, and 0.7% had a poor quality of life. There are no significant differences in quality of life-based on age, gender, diagnosis, and duration of drug use.

Keywords: antiplatelet, quality of life, coronary artery disease, coronary heart disease

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10367 A Cross-Sectional Study Assessing Communication Practices among Doctors at a University Hospital in Pakistan

Authors: Muhammad Waqas Baqai, Noman Shahzad, Rehman Alvi

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Communication among health care givers is the essence of quality patient care and any compromise results in errors and inefficiency leading to cumbersome outcomes. The use of smartphone among health professionals has increased tremendously. Almost every health professional carries it and majority of them uses a third party communication software called whatsApp for work related communications. It gives instant access to the person responsible for any particular query and therefore helps in efficient and timely decision making. It is also an easy way of sharing medical documents, multimedia and provides platform for consensual decision making through group discussions. However clinical communication through whatsApp has some demerits too including reduction in verbal communication, worsening professional relations, unprofessional behavior, risk of confidentiality breach and threats from cyber-attacks. On the other hand the traditional pager device being used in many health care systems is a unidirectional communication that lacks the ability to convey any information other than the number to which the receiver has to respond. Our study focused on these two widely used modalities of communication among doctors of the largest tertiary care center of Pakistan i.e. The Aga Khan University Hospital. Our aim was to note which modality is considered better and has fewer threats to medical data. Approval from ethical review committee of the institute was taken prior to conduction of this study. We submitted an online survey form to all the interns and residents working at our institute and collected their response in a month’s time. 162 submissions were recorded and analyzed using descriptive statistics. Only 20% of them were comfortable with using pagers exclusively, 52% with whatsApp and 28% with both. 65% think that whatsApp is time-saving and quicker than pager. 54% of them considered whatsApp to be causing nuisance from work related notifications in their off-work hours. 60% think that they are more likely to miss information through pager system because of the unidirectional nature. Almost all (96%) of residents and interns found whatsApp to be useful in terms of saving information for future reference. For urgent issues, majority (70%) preferred pager over whatsApp and also pager was considered more valid in terms of hospital policies and legal issues. Among major advantages of whatsApp as listed by them were; easy mass communication, sharing of clinical pictures, universal access and no need of carrying additional device. However the major drawback of using whatsApp for clinical communication that everyone shared was threat to patients’ confidentiality as clinicians usually share pictures of wounds, clinical documents etc. Lastly we asked them if they think there is a need of a separate application for instant communication dedicated to clinical communication only and 90% responded positively. Therefore, we concluded that both modalities have their merits and demerits but the greatest drawback with whatsApp is the risk of breach in patients’ confidentiality and off-work disturbance. Hence, we recommend a more secure, institute-run application for all intra hospital communications where they can share documents, pictures etc. easily under a controlled environment.

Keywords: WhatsApp, pager, clinical communication, confidentiality

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10366 Suicidal Attempts as a Reason for Emergency Medical Teams’ Call-Outs Based on Examples of Ambulance Service in Siedlce, Poland

Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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10365 Determinants of Child Malnutrition in Sub-Saharan Africa

Authors: Habtamu Fufa, Yemane Berhane

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Child under nutrition has long-term consequences for intellectual ability, economic productivity, reproductive performance and susceptibility to metabolic and cardiovascular disease. The unacceptably high prevalence of malnutrition in young children of the region has not changed much over the last decades, which could make the achievement of the corresponding Millennium Development Goals very unlikely. Despite the well-documented problems of child malnutrition in Sub-Saharan Africa, there is few systematic review of evidences on determinants of child malnutrition in the region. The current available evidence on determinants of child under nutrition in Sub-Saharan Africa is systematically reviewed. The method used in searching relevant literature was using bio medical databases PUBMED, Google scholar and the website of the World Health Organization on nutrition using the following key words: "Determinants “, "Child Malnutrition", and "Sub- Saharan Africa". The search was limited to articles published in and after 1995 up to date. In all the reviewed articles, the data were analyzed using multivariate regression analysis and or odds ratios for significance of determinants in child malnutrition. Synthesis of 40 published articles from various countries of the region is done and noted that household economic status, maternal education, disease, breastfeeding practices, age and sex of a child, birth interval and residential areas were found to be determinants of child under nutrition. Poverty remains the main factor of malnutrition in Sub-Saharan Africa and poor education of parents aggravates the malnutrition through perpetuation of poor nutrition practices. Male children under five years are the most affected ones. Understanding of these determinants of poor nutritional attainment would provide insights in designing interventions for reducing the high levels of child malnutrition in this region. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child nutritional & health status in Sub-Saharan Africa.

Keywords: child malnutrition, determinants, Sub-Saharan Africa, health status

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10364 Analysis of Trends in Environmental Health Research Using Topic Modeling

Authors: Hayoung Cho, Gabi Cho

Abstract:

In response to the continuing increase of demands for living environment safety, the Korean government has established and implemented various environmental health policies and set a high priority to the related R&D. However, the level of related technologies such as environmental risk assessment are still relatively low, and there is a need for detailed investment strategies in the field of environmental health research. As scientific research papers can give valuable implications on the development of a certain field, this study analyzed the global research trends in the field of environmental health over the past 10 years (2005~2015). Research topics were extracted from abstracts of the collected SCI papers using topic modeling to study the changes in research trends and discover emerging technologies. The method of topic modeling can improve the traditional bibliometric approach and provide a more comprehensive review of the global research development. The results of this study are expected to help provide insights for effective policy making and R&D investment direction.

Keywords: environmental health, paper analysis, research trends, topic modeling

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10363 The Social Aspects of Mental Illness among Orthodox Christians of the Tigrinya Ethnic Group in Eritrea

Authors: Erimias Firre

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This study is situated within the religio-cultural milieu of Coptic Orthodox Christians of the Tigrinya ethnic group in Eritrea. With this ethnic group being conservative and traditionally bound, extended family structures dissected along various clans and expansive community networks are the distinguishing mark of its members. Notably, Coptic Tigrinya constitutes the largest percentage of all Christian denominations in Eritrea. As religious, cultural beliefs, rituals and teachings permeate in all aspects of social life, a distinct worldview and traditionalized health and illness conceptualization are common. Accordingly, this study argues that religio-culturally bound illness ideologies immensely determine the perception, help seeking behavior and healing preference of Coptic Tigrinya in Eritrea. The study bears significance in the sense that it bridges an important knowledge gap, given that it is ethno-linguistically (within the Tigrinya ethnic group), spatially (central region of Eritrea) and religiously (Coptic Christianity) specific. The conceptual framework guiding this research centered on the social determinants of mental health, and explores through the lens of critical theory how existing systems generate social vulnerability and structural inequality, providing a platform to reveal how the psychosocial model has the capacity to emancipate and empower those with mental disorders to live productive and meaningful lives. A case study approach was employed to explore the interrelationship between religio-cultural beliefs and practices and perception of common mental disorders of depression, anxiety, bipolar affective, schizophrenia and post-traumatic stress disorders and the impact of these perceptions on people with those mental disorders. Purposive sampling was used to recruit 41 participants representing seven diverse cohorts; people with common mental disorders, family caregivers, general community members, ex-fighters , priests, staff at St. Mary’s and Biet-Mekae Community Health Center; resulting in rich data for thematic analysis. Findings highlighted current religio-cultural perceptions, causes and treatment of mental disorders among Coptic Tigrinya result in widespread labelling, stigma and discrimination, both of those with mental disorders and their families. Traditional healing sources are almost exclusively tried, sometimes for many years, before families and sufferers seek formal medical assessment and treatment, resulting difficult to treat illness chronicity. Service gaps in the formal medical system result in the inability to meet the principles enshrined in the WHO Mental Health Action Plan 2013-2020 to which the Eritrean Government is a signatory. However, the study found that across all participant cohorts, there was a desire for change that will create a culture whereby those with mental disorders will have restored hope, connectedness, healing and self-determination.

Keywords: Coptic Tigrinya, mental disorders, psychosocial model social integration and recovery, traditional healing

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10362 Health Outcomes and Economic Growth Nexus: Testing for Long-run Relationships and Causal Links in Nigeria

Authors: Haruna Modibbo Usman, Mustapha Muktar, Nasiru Inuwa

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This paper examined the long run relationship between health outcomes and economic growth in Nigeria from 1961 to 2012. Using annual time series data, Augmented Dickey-Fuller (ADF) test is conducted to check the stochastic properties of the variables. Also, the long run relationship among the variables is confirmed based on Johansen Multivariate Cointegration approach whereas the long run and short run dynamics are observed using Vector Error Correction Mechanism (VECM). In addition, VEC Granger causality test is employed to examine the direction of causality among the variables. On the whole, the results obtained revealed the existence of a long run relationship between health outcomes and economic growth in Nigeria and that both life expectancy and crude death rate as measures of health are found to have a long run negative and statistically significant impact on the economic growth over the study period. This is further buttressed by the results of Granger causality test which indicated the existence of unidirectional causality running from life expectancy and crude death rate to economic growth. The study therefore, calls for governments at various levels to create preconditions for health improvements in Nigeria in order to boost the level of health outcomes.

Keywords: cointegration, economic growth, Granger causality, health outcomes, VECM

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10361 Virtual Reality Learning Environment in Embryology Education

Authors: Salsabeel F. M. Alfalah, Jannat F. Falah, Nadia Muhaidat, Amjad Hudaib, Diana Koshebye, Sawsan AlHourani

Abstract:

Educational technology is changing the way how students engage and interact with learning materials. This improved the learning process amongst various subjects. Virtual Reality (VR) applications are considered one of the evolving methods that have contributed to enhancing medical education. This paper utilizes VR to provide a solution to improve the delivery of the subject of Embryology to medical students, and facilitate the teaching process by providing a useful aid to lecturers, whilst proving the effectiveness of this new technology in this particular area. After evaluating the current teaching methods and identifying students ‘needs, a VR system was designed that demonstrates in an interactive fashion the development of the human embryo from fertilization to week ten of intrauterine development. This system aims to overcome some of the problems faced by the students’ in the current educational methods, and to increase the efficacy of the learning process.

Keywords: virtual reality, student assessment, medical education, 3D, embryology

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10360 Mental Health Stigma: Barriers to Treatment and Participation in Mental Health Care among University Students in Kenya

Authors: Scholastic Nangila Adeli, Francisca Mbutitia Ngithi

Abstract:

Stigma is commonly associated with mental health patients and may act as a barrier to individuals who may seek or engage in treatment services. Stigmatization among university students is common whether they know someone with a mental health problem, or have a good knowledge and experience of mental health issues. The objective of this study was to establish the various barriers that prevent university students who have mental health challenges from seeking treatment and care. The study was a descriptive in nature where 320 respondents helped to establish the barriers to treatment or participation in mental health care among university students. A questionnaire was used to help establish the barriers and attitude towards mental illness among the respondents. Results from this study revealed that mental illnesses are common among university students and they are manifested in different forms like; anxiety and panic attacks, mood and eating disorders, Impulse control leading to gambling, alcohol and drug addictions, anger and depression leading to loneliness. Mental stigma (both social and self) was the major barrier with 62% of the respondents stating that social stigma was worse than self-stigma. This is because of the social discrimination towards the victim of mental challenges. On issues of attitude, 71% of the respondents said that they can never admit that they have a mental issue and would rather secretly seek clinical or psychological help for fear of being discriminated or excluded by peers. This view is informed by the societal belief that people with mental health challenges were dangerous (associating them with criminal behavior) and hard to socialize with or help. From the findings of this study, it is concluded that mental health problems are real among university students in Kenya and it is important for the university environment to minimize or eradicate stigma within the social circles. Stigma can be minimized or eradicated by creating awareness among university students and fostering social inclusion so that the students who have mental health challenges can experience a sense of belonging and acceptance hence build their self-esteem.

Keywords: disorders, impulse control, mental health problems, stigma

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10359 Impact of the COVID-19 Pandemic on the Maternal, Newborn, Child Health and Nutrition Indicators in Miagao, Iloilo and Sibunag, Guimaras, Philippines

Authors: Franco Miguel Nodado, Adrienne Marie Bugayong Janagap, Allen Claire Arances, Kirsten Anne Gerez, Frances Catherine Rosario, Charise Alvyne Samaniego, Matt Andrew Secular, Rommel Gestuveo, Marilyn Sumayo, Joseph Arbizo, Philip Ian Padilla

Abstract:

COVID-19 pandemic adversely affected the delivery of health care services, but its impacts on Maternal, Newborn, Child Health and Nutrition (MNCHN) programs in rural municipalities in the Philippines remains understudied. Thus, this study explored the effects of the pandemic on MNCHN indicators in the municipalities of Miagao, Iloilo and Sibunag, Guimaras. A cross-sectional design was employed to compare the MNCHN indicators before and during the pandemic, and between Miagao and Sibunag. Key informant interviews (KII) were performed to identify the factors affecting access to MNCHN programs. During the pandemic, Miagao had a significant increase in positive outcomes of eight out of ten maternal health indicators, while Sibunag showed a significant decrease in six indicators. For child health and nutrition, Miagao obtained significant improvements in five of seven indicators, while Sibunag showed a significant increase in positive outcomes for six. KII data showed that the primary concern of mothers in Miagao is accessibility, while mothers in Sibunag raised concerns on accessibility, availability, and affordability of these MNCHN services. Miagao MHO employed various strategies such as telemedicine, activation of barangay health workers, and decentralization of health services to Barangay Health Centers, which can explain the improvements in MNCHN indicators. Sibunag also decentralized its health services, but its limited resources might have led them to prioritize child health and nutrition services. The findings suggest that the impacts of the COVID-19 pandemic on MNCHN depend on local health measures employed by the municipality, while telemedicine is a very useful tool in mitigating the negative effects of disrupted health services.

Keywords: maternal, child, COVID-19, Miagao, Sibunag, nutrition

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10358 Health Services for Women Refugees: A Quantitative Exploratory Study in Ottawa, Canada

Authors: Kholoud Sheba

Abstract:

Women refugees expectedly are physical, socially and mentally vulnerable due to their past traumatic experiences and their novel circumstances in their receiving countries. They may have a wide range of general, mental, and reproductive health problems, but reportedly avoid visiting health care facilities owing to complex elements. Women refugees are usually unfamiliar with their new country health system and unable to navigate it efficiently. They have limited English language skills, which makes it even harder to access culturally insensitive health services. This study examines barriers to health care for refugee women in Ottawa and offers suggestions to address these challenges. Drawing from culturally congruent health care models in Canada, the United Kingdom, and some parts of the United States, this study highlights the importance of cultivating compassion in the provision of health care for women refugees as a way of addressing some of the disparities in health care in Canada. To address the study purpose, a survey questionnaire was designed and pretested questionnaire and was administrated using SurveyMonkey, a paid source survey application, over a period of two weeks. Snowballing sampling procedures were used to recruit the participants. Data was measured using frequencies, percentages, t-test, ANOVA, and chi-square. The test of significance is set at p < .05. The study asked how refugees perceive their experience in accessing and navigating public health services in Ottawa; what challenges refugees face with healthcare in Canada, and, if gender is related to refugees’ perceptions of the health care system they are forced to use? Results show refugees perceived their experience accessing the healthcare services in Canada to be a positive experience and the health providers to be culturally sensitive and allowing enough time listening to their complaints. The language stood tall in their barriers accessing the services due to low English proficiency and the need for interpretation services to encourage them attending the services.

Keywords: women refugee, access barriers, Ottawa, resettlement

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10357 Competing Discourses of Masculinity and Seeking Mental Health Assistance among Male Police Officers in Canada

Authors: Maria T. Cruz, Scott N. Thompson

Abstract:

In recent years, Canadian federal and provincial law enforcement organizations have implemented numerous mental health strategies in an attempt to address officers’ mental health and wellness needs. Despite these reforms, however, mental illness continues to persist in these populations. Whereas workplace stressors continue to be factored into the development of mental health initiatives, it is proposed that aspects of masculine culture have been overlooked as contributing to the prevalence of mental illness among Canadian officers. By drawing on Michel Foucault’s theory of discourse, this study was conducted to determine if elements of masculine discourse exist as a socio-cultural barrier for officers seeking mental health assistance. This research supported the above hypothesis, and furthermore, identified how masculine discourse works in competition with mental health-related help-seeking discourses. To answer the research question, semi-structured phone interviews with active and retired male officers from Western provincial and municipal policing organizations, and the Royal Canadian Mounted Police were employed. Through thematic analysis of the transcripts, the data revealed three themes: i) masculinity in law enforcement is a determinant of workplace competency; ii) the dominance of masculine culture in law enforcement is problematic for mental health, and iii) improved help-seeking policies complicate how masculinity is expressed in law enforcement organizations. These findings suggest that within the reviewed Canadian law enforcement organizations, aspects of masculinity act as a socio-cultural barrier to officers seeking mental health services, and that the two conflicting discourses of masculinity and mental health-related help-seeking appear to be in competition with each other.

Keywords: competing discourses, dominant discourses, Foucault’s theory of discourse, law enforcement, masculinity, mental health, police officers

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10356 Completion of the Modified World Health Organization (WHO) Partograph during Labour in Public Health Institutions of Addis Ababa, Ethiopia

Authors: Engida Yisma, Berhanu Dessalegn, Ayalew Astatkie, Nebreed Fesseha

Abstract:

Background: The World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. Methods: A retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study. Results: All facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed. Conclusions: This study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.

Keywords: modified WHO partograph, completion, public health institutions, Addis Ababa, Ethiopia

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10355 Training Can Increase Knowledge and Skill of Teacher's on Measurement and Assessment Nutritional Status Children

Authors: Herawati Tri Siswati, Nurhidayat Ana Sıdık Fatimah

Abstract:

The Indonesia Basic Health Research, 2013 showed that prevalence of stunting of 6–12 children years old was 35,6%, wasting was 12,2% and obesiy was 9,2%. The Indonesian Goverment have School Health Program, held in coordination, plans, directing and responsible, developing and implement health student. However, it's implementation still under expected, while Indonesian Ministry of Health has initiated the School Health Program acceleration. This aimed is to know the influencing of training to knowledge and skill of elementary school teacher about measurement and assesment nutrirional status children. The research is quasy experimental with pre-post design, in Sleman disctrict, Yogyakarta province, Indonesia, 2015. Subject was all of elementary school teacher’s who responsible in School Health Program in Gamping sub-district, Sleman, Yogyakarta, i.e. 32 persons. The independent variable is training, while the dependent variable are teacher’s klowledge and skill on measurement and assesment nutrirional status children. The data was analized by t-test. The result showed that the knowledge score before training is 31,6±9,7 and after 56,4±12,6, with an increase 24,8±15,7, and p=0.00. The skill score before training is 46,6±11,1 and after 61,7±13, with an increase 15,2±14,2, p = 0.00. Training can increase the teacher’s klowledge and skill on measurement and assesment nutrirional status.

Keywords: training, school health program, nutritional status, children.

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10354 Influence of Marital Status on Nutritional, Physical, Mental, and Social Health: A Study on Women in Faisalabad, Pakistan

Authors: Anum Obaid, Iman Fatima, Wanisha Feroz, Haleema Imran, Hammad Tariq

Abstract:

Unmarried women over thirty years of age as a health issue is a relatively young phenomenon, but it is rapidly growing in Pakistan; therefore, it is a public health issue. The challenges affecting nutrition and public health are some of the indispensable components that need to be met to achieve sustainable development goals (SDGs). This research intends to explain these goals in the context of nutrition and public health, especially analyzing the issues related to unmarried women above the age of thirty in Faisalabad, Pakistan. Still, this research is not feasible in Pakistan. In Pakistan alone, 10 million women over the age of 35 are unmarried, based on a recent United Nations report. The United Nations, in cooperation with the World Health Organization, has identified health as a state of being healthy, free from illness or disease, and not just a condition where there are no diseases or bodily disabilities. The current generation of women is unmarried and living a life under constant pressure from society to deliver changes like the diet these women take, and hence, their nutritional status defines their comprehensive health triangle, a mix of physical, mental, and social well-being. The research was carried out under the qualitative research paradigm, specifically through interviews with the participants who were unmarried women and married women above the age of thirty. This qualitative study explores how marriage affects the intake of nutrients, nutritional health, psychological and social well-being and their effects. The realization of well-being consisted of factors like physical health, mental and emotional health, pressure from society, social health, economic independence, and decision-making power to reveal the impact of singleness on well-being. The findings disclosed that marital status had a notable impact on the diet habits and nutritional behaviors of women in Faisalabad. Also, it was found that single women suffer from more stress and are not as positive as married women because they are lonely, as their husbands are absent from their lives. The findings established that nutritional understanding is differentially affected by marital status as a determinant of the health triangle consisting of physical, mental, and social health. Awareness of these factors is significant in designing specific goal-directed interventions that can enhance the nutritional well-being and general health status of unmarried women in Faisalabad. Hence, this study underscores the necessity of maintaining supportive environments and increasing the regard concerning the health state of single ladies beyond thirty.

Keywords: health triangle, over thirty, singleness, age barriers, unmarried women, women’s health, well-being

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10353 Development and Implementation of E-Disease Surveillance Systems for Public Health Southern Africa: A Critical Review

Authors: Taurai T. Chikotie, Bruce W. Watson

Abstract:

The manifestation of ‘new’ infectious diseases and the re-emergence of ‘old’ infectious diseases now present global problems and Southern Africa has not been spared from such calamity. Although having an organized public health system, countries in this region have failed to leverage on the proliferation in use of Information and Communication Technologies to promote effective disease surveillance. Objective: The objective of this study was to critically review and analyse the crucial variables to consider in the development and implementation of electronic disease surveillance systems in public health within the context of Southern Africa. Methodology: A critical review of literature published in English using, Google Scholar, EBSCOHOST, Science Direct, databases from the Centre for Disease Control (CDC and articles from the World Health Organisation (WHO) was undertaken. Manual reference and grey literature searches were also conducted. Results: Little has been done towards harnessing the potential of information technologies towards disease surveillance and this has been due to several challenges that include, lack of funding, lack of health informatics experts, poor supporting infrastructure, an unstable socio-political and socio-economic ecosystem in the region and archaic policies towards integration of information technologies in public health governance. Conclusion: The Southern African region stands to achieve better health outcomes if they adopt the use of e-disease surveillance systems in public health. However, the dynamics and complexities of the socio-economic, socio-political and technical variables would need addressing to ensure the successful development and implementation of e-disease surveillance systems in the region.

Keywords: critical review, disease surveillance, public health informatics, Southern Africa

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10352 Importance of Occupational Safety and Health in Dam Construction Site

Authors: Naci Büyükkaraciğan, Yildirim Akyol

Abstract:

Large plants that covering the back and accumulate water of a river valley for energy production, drinking, irrigation water supply, economic benefits that serve many purposes, such as regulation of flood protection, are called dams. Place, in which unites in order to achieve an optimum balance between manpower for Lowest cost and economic as belonging to that structure to create machines, materials and construction of the project, is called as the site. Dam construction sites are combined sites in together in many businesses. Therefore, there can be found in the many workers and machines are many accidents in this type of construction sites. The necessity of systematic and scientific studies due to various reasons arises in order to be protected from conditions that could damage the health, During the execution of the work on construction sites. Occupational health and safety of the study, called the case, also in the European Union has begun to be addressed by weight since the 1980s. In particular, issued in 1989 89/391/EEC on occupational health and safety directive, occupational health and adopted the Directive within the framework of the security field, and then exposed to a large number of individual directive within this framework on the basis of the directive. Turkey's Law No. 6331 entered into force in June 2012 on the subject. In this study, measures related to the construction site of the dam should be taken with occupational safety and health have been examined and tried to put forward recommendations on the subject.

Keywords: civil engineering, dam, occupational safety and health, site organizations

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10351 Testing Causal Model of Depression Based on the Components of Subscales Lifestyle with Mediation of Social Health

Authors: Abdolamir Gatezadeh, Jamal Daghaleh

Abstract:

The lifestyle of individuals is important and determinant for the status of psychological and social health. Recently, especially in developed countries, the relationship between lifestyle and mental illnesses, including depression, has attracted the attention of many people. In order to test the causal model of depression based on lifestyle with mediation of social health in the study, basic and applied methods were used in terms of objective and descriptive-field as well as the data collection. Methods: This study is a basic research type and is in the framework of correlational plans. In this study, the population includes all adults in Ahwaz city. A randomized, multistage sampling of 384 subjects was selected as the subjects. Accordingly, the data was collected and analyzed using structural equation modeling. Results: In data analysis, path analysis indicated the confirmation of the assumed model fit of research. This means that subscales lifestyle has a direct effect on depression and subscales lifestyle through the mediation of social health which in turn has an indirect effect on depression. Discussion and conclusion: According to the results of the research, the depression can be used to explain the components of the lifestyle and social health.

Keywords: depression, subscales lifestyle, social health, causal model

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10350 A Qualitative Study of Health-Related Beliefs and Practices among Vegetarians

Authors: Lorena Antonovici, Maria Nicoleta Turliuc

Abstract:

The process of becoming a vegetarian involves changes in several life aspects, including health. Despite its relevance, however, little research has been carried out to analyze vegetarians' self-perceived health, and even less empirical attention has received in the Romanian population. This study aimed to assess health-related beliefs and practices among vegetarian adults in a Romanian sample. We have undertaken 20 semi-structured interviews (10 males, 10 females) based on a snowball sample with a mean age of 31 years. The interview guide was divided into three sections: causes of adopting the diet, general aspects (beliefs, practices, tensions, and conflicts) and consequences of adopting the diet (significant changes, positive aspects, and difficulties, physical and mental health). Additional anamnestic data were reported by means of a questionnaire. Data analyses were performed using Tropes text analysis software (v. 8.2) and SPSS software (v. 24.0.) Findings showed that most of the participants considered a vegetarian diet as a natural and healthy choice as opposed to meat-eating, which is not healthy, and its consumption should be moderated among omnivores. A higher proportion of participants (65%) had an average body mass index (BMI), and several women even assumed having certain affections that no longer occur after following a vegetarian diet. Moreover, participants admitted having better moods and mental health status, given their self-contentment with the dietary choice. Relatives were perceived as more skeptical about their practices than others, and especially women had this view. This study provides a valuable insight into health-related beliefs and practices and how a vegetarian diet might interact.

Keywords: beliefs, health, practices, vegetarians

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10349 Increasing National Health Insurance Scheme Enrolment in Ghana: Pro-Rata Insurance Premium Payment with Mobile Phone as the Answer

Authors: Joseph Marfo Boaheng, Daniel Ansong, Eugenia Amporfo

Abstract:

Health Insurance is proposed to provide financial protection against catastrophic health care cost arising from disease. Ghana has had a National Health Insurance Scheme (NHIS) since 2003 with the current enrolment/retention rate of 36%. The main goal of the scheme is to provide equity in the health sector as well as ensuring affordable health care for the poor. However, the current payment system is not flexible to attract significant proportion of the poor informal sector onto the scheme. Looking at the extensive use of mobiles in the Ghana where about 29,220,602.00 registered mobile phone lines are actively in used as of June 2014, paying health insurance premium through mobile phone could be feasible to attract larger proportion of the informal sector onto the scheme. Methodology: The quantitative cross-sectional survey was used to solicit the required information from 877 respondents living in Kumasi, the second capital city of Ghana. The magnitude of the effect of Pro-rata system (flexible payment terms) on NHIS enrollment rate was estimated with binary logistic regression model. Results: The odds for an individual to enroll onto NHIS with mobile phone increases about 2 times more when payment of insurance premium is on pro-rata basis ie. flexible payment terms (p=0.008, CI=1.212-3.565). Conclusion: The study advocates the National Health Insurance Authority consider this alternative payment system that has the potential of attracting a greater proportion of the informal sector to be enrolled or retained onto the scheme.

Keywords: enrollment, health insurance, mobile phone, pro-rata

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10348 Quality of Care of Medical Male Circumcisions: A Non-Negotiable for Right to Care

Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

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