Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

Background There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: (1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; (2) health center capacity building for provision of LARC methods, and (3) LARC promotion by community health workers (CHW) trained in community-based provision of oral and injectable contraception. From 2015 to 2016, this service was integrated into eight government health centers in Kigali, reaching 6072 clients and resulting in 5743 LARC insertions. Methods From May to July 2016, we conducted cross-sectional health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision. Results Few nurses had received training in LARC insertion [41% implant, 27% intrauterine device (IUD)]. All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (median 10), implants (median 39), functional gynecological exam tables (median 2), and lamps for viewing the cervix (median 0). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.

Association of maternal oral health with early childhood caries among rural areas of Punjab

Aim: To explore the relationship between oral health status of mothers and caries prevalence of caries among their children in rural areas of Pakistan. Methodology: This crossectional study was conducted in 9 rural health centers of Punjab, Pakistan. Purposive convenient sampling was used to collect data. Sample size was 500 mothers with their children. Results: Socioeconomic status of family as well as the purpose for the last visit at dental hospital for the treatment of child were found positively linked with the dmfs of child. Sample of children at very low socioeconomic status (OR: 2.16; 95%CI: 1.36-2.98). Children who visited dental hospital with the reason of having dental problems (OR: 1.89; 95%CI: 1.25-2.59). Greater dmfs score was found among children with poor oral hygiene (OR: 1.98; 95%CI: 1.27-3.25). The education of mother was found to be negatively linked with dmfs score of child. Conclusion: The relationship between maternal and dental caries in children was clearly explained by socioeconomic status or dental behaviors of mother and child in terms of intake of sugar, oral hygiene and reason for last dental visit for child. Keywords: Maternal oral health, dmfs, childhood carries

Healthcare System of Pakistan: Strengths and Weaknesses

Each country of the world has its own health care system to follow, Pakistan has followed the healthcare system designed by British rulers since 1947. Primary healthcare, Secondary Healthcare and tertiary healthcare are the major parts of the defined healthcare system that are been practiced across the country. Pakistan has always participated and encouraged health promotion and delivery participating in Millennium Development Goal (MDG) program, encouraging public private partnership, investing in improvement of human resources and skills, introducing Basic Health Units (BHUs) and Rural Health centers. Though investment and inputs are set at achieving health for all but many weaknesses have slowed down the process of development. Poor governance and monitory policy, political influence and budget allocation issues have made it difficult to provide health on equal basis. The current review is aimed to discuss the strengths and weaknesses of healthcare system of Pakistan.

Relationship Between Sexual Satisfaction and Mental Health in Married Older Women

Background: The aging population is increasing rapidly; therefore, paying attention to the needs of older people is necessary. Sexual satisfaction, which is needed to feel happy, is often neglected in older women. Objective: This study aims to evaluate the relationship between sexual satisfaction and mental health in older women. Materials and Methods: In this analytical study with a cross-sectional design, 195 married women aged ≥60 years covered by urban and rural health centers of Guilan, Iran were recruited using a cluster sampling method. A demographic form, the 28-item General Health Questionnaire (GHQ-28) and a Sexual Satisfaction Questionnaire were completed by participants and collected data were analyzed in SPSS v. 22 software using descriptive statistics (frequency, mean, standard deviation, median), and Mann-Whitney U, Kruskal-Wallis and Spearman correlation tests. Results: There was a significant relationship between sexual satisfaction and mental health in older women (P<0.0001). 51.2%, 27.7% and 21.08% of participants had low, moderate and high sexual satisfaction, respectively. Sexual satisfaction was directly related to monthly income (P<0.0001) and women’s and their husbands’ education (P<0.0001 and 0.006) while it was inversely related to physical illness (P=0.030), medication use (P=0.009), age (P<0.0001), number of children (P=0.022), and duration of marriage (P<0.0001). The median score of mental health in participants was 38 (ranging 24-53) and the percentage of participants with mental problems (79.4%) was higher than those without mental problems (20.6%). Conclusion: Mental health and sexual satisfaction in older women are directly related to each other; therefore, providing effective and appropriate sexual care programs is recommended for them.

Study of awareness, attitude, and utilization of Complementary and Alternative Medicine among patients visiting urban and rural health centers

Worldwide there is a recent increase in the usage of Complementary and Alternative Medicine (CAM), which has been defined as a group of diverse medical and healthcare systems, practices and products that are presently not considered to be a part of conventional medicine. The objectives were to assess and to compare the awareness, perspective, and utilization of CAM among urban and rural patients. A cross-sectional study was conducted among 200 out-patients attending the urban and rural health centers with a standardized questionnaire. MS Excel and Epi Info were used for data entry and analysis. The awareness of CAM was 71% of urban patients and 63% of rural patients. Despite the awareness of CAM, the urban patient either liked CAM (32%) or apathetic towards CAM (32%) and rural patients mostly apathetic towards CAM (47%). Both areas of patients (41%) used CAM, of which 36% were urban patients and 46% were rural patients. There is a higher proportion of aware patients in rural areas (73%) used CAM when compared to the usage of CAM by aware patients in the urban area (51%). Despite the usage of CAM, both areas of patients preferred Allopathy. In summary, this study demonstrated that most patients are aware of CAM, but patients were mostly apathetic towards CAM. Around half of the patients utilized alternative medicine.

Impact Of High Involvement Work Practices On Employee Performances In Health Sector, Pakistan

Purpose of the Study: This study was aimed to evaluate the association of different dimensions of high involvement work practices with employee performance in the health department. These high involvement practices are shared decision making, compensation and rewards, shared information and organizational training. Methodology: This research adopted the quantitative techniques for collecting and analyzing the data. Data was collected through a survey, and the questionnaire has been adopted as the tool of data collection. This survey has targeted the employees of health department that includes doctors, nutritionists, dispensers and other staff at rural health centers. This survey has selected 202 employees through distributing the questionnaires, after collecting all the questionnaires, data has recorded in SPSS for analyzing statistically. Findings: Results showed that all four dimensions of employee involvement keep a significant association with employee performances. All the variables in this study keep a significant relationship with each other. Discussion & Conclusion: Furthermore, it has revealed that shared information and organizational training keep the increasing importance of effecting employee performances. This research has highlighted the essential recommendations and directions for further studies. Novelity of the Study: The stronger correlation has been assessed among rewards and employee performances. Separate impact of such factors like competitive salaries, fair rewards and recognition system have been found as significantly associated with the higher performance level of the employee performance in the organizations.