Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India

ABSTRACTA delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient’s cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21–60) days; median patient delay seven (IQR: 2–21) days, median health system delay 16 (IQR: 8–45) days, median diagnostic delay 32.5 (IQR: 18–57) days, and median treatment delay two (IQR: 1–3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India’s target to eliminate TB by 2025.

Gastrosquisis en Hospital IESS “Manuel Ygnacio Monteros”. Presentación de caso clínico y revisión bibliográfica

BACKGROUND: Gastroschisis is an anomaly in which abdominal organs are exposed outside the abdominal wall. The global average prevalence is 1.36 for each 10 000 newborns. In Ecuador, according to the National Institute of Statistics and Censuses (INEC), there is evidence of an increase in the number of hospital discharges with this diagnosis, reaching 52 in 2010, 85 in 2012, and 112 patients in 2015. The aim of this publication is to describe this pathology and expose the importance of prenatal diagnosis to plan prompt surgical intervention for the newborn after birth. CASE REPORT: newborn from a 16-year-old primigravid mother, with no other prenatal history, four ultrasounds were performed during pregnancy in a private health facility, which reported no alterations. At 37.4 weeks of pregnancy, the newborn was delivered by eutocic birth, showing gastroschisis. The patient underwent laparotomy and peritoneostomy at 24 hours of age, delayed closure was scheduled. EVOLUTION: the newborn received comprehensive care in the neonatal intensive care unit. Delayed closure was performed eight days later. He remained hospitalized for 22 days, he received parenteral nutrition and started trophic feeding at 15 days of age; first-line antibiotic therapy was initiated, however due to torpid evolution, he required a change to a broad-spectrum antibiotic. CONCLUSION: gastroschisis can be detected in ultrasound from the twelve week of pregnancy to minimize complications and program the surgical procedure immediately after birth.

Survey of Patient Satisfaction with Radiological Services in Public and Private Health Facilities in Kano

Background: Patient satisfaction is the extent to which the patients feel that their needs and expectations are being met by the service provider. The survey of patient satisfaction with health care services is a growing concept in Nigeria, where study on this subject is just beginning to develop. Objective: The aim of this study was to compare the patients’ satisfaction level with radiological services and to identify the factors that may account for the differences in their satisfaction between a public and a private health facility in Kano state Nigeria. Method: The study was a cross-sectional prospective survey that targeted patients who visited radiology departments. Data was collected using a 43 item self-completion questionnaire designed in line with the objectives of the study. The data were categorized into groups and analysed using a statistical package for social sciences version 20.0, where descriptive statistics such as the percentages and frequencies were generated and tabulated. A chi-square test was used to test for the differences in the patients’ satisfactory level at (p<0.05). Results: The results showed that 60.7% (n=85) were female while 39.3% (n=55) were male, 52.2% (n=47) of the respondents from the public hospital were dissatisfied, while 47.8% (n=43) were satisfied. At the private hospital, only 20% (n=10) were dissatisfied, while 80% (n=40) were satisfied with the radiological services received. The type of health facility and patients’ satisfaction was found to be statistically significant at (p<0.05). Conclusion: The patients in the private health facility of the study were more satisfied than those at the public health facility because of prompt attention given to them immediately after arrival, immediate collection of their radiological reports, and high ergonometric environment provided by the hospital staff.

A study to assess receipt and utilization of janani suraksha yojana cash incentive among mothers in urban slums of Raipur city, Chhattisgarh, India

Background: Janani Suraksha Yojana (JSY) replaces the National Maternity Benefit Scheme. It was launched by the Government of India in April 2005. The aim was to reduce maternal and neonatal mortality by increasing institutional delivery by providing cash incentive to the beneficiaries as well as the link worker ASHA. Objectives of this study was to assess receipt of Janani Suraksha Yojana (JSY) cash incentive and to assess fields of utilization of Janani Suraksha Yojana (JSY) cash incentive.Methods: A Community based cross-sectional study was conducted among 384 mothers delivered within last one year in urban slum of Raipur city. Study centre was department of community medicine, Pt. J.N.M. medical college Raipur, Chhattisgarh. A pre-designed and pre-tested questionnaire was used to interview the study subjects.Results: Out of total 384 study subject’s cheque of JSY cash incentive was received by 70.83%. All (100%) beneficiaries who received cheque was stipulated amount as per JSY guideline. Reasons for not receiving cheque was no availability of BPL card for those who delivered in accredited private health facility. Other reasons were absconded after delivery, unaware of cash incentive, did not go back to get the cheque when called later, patient shifted to another ward. None of the study subjects who delivered at home received the cash incentive cheque. Realization of cheque was not done by 22.79% of study subjects due to complex procedure to open an account in bank. Cash incentive money was utilized in neonatal care, drugs, food, household activities and some deposited in bank.Conclusions: JSY scheme is definitely functioning well in terms of providing cash incentive cheque of JSY on delivery in Government Health facility. There is need to simplify the procedure to open an account so that beneficiaries can avail cash incentive money. There is need to address the problems to receive cheque in home delivery and accredited Private health facility in addition to motivation for institutional delivery.

A rare case report of aural myiasis in a 24-day old neonate in Tanzania

<p>Aural myiasis refers to the infestation of the ear by the larvae of certain dipterous flies. The disease-producing flies prefer a warm and humid environment and higher incidence occur in tropics and subtropics of Africa and America. Aural myiasis is rare during neonatal life and children with tendencies of poking the ear need immediate review by otorhinolaryngologists for thorough otological review. The objective is thus to report the case of a 24-day old neonate who was diagnosed to have aural myiasis upon otoendoscopy at a private health facility in Tanzania. This is the first reported case of neonatal aural myiasis in our country. Neonates with tendencies to poke ears and with irritability should be handled with care by having immediate Otorhinolaryngologist review to exclude aural pathologies such as aural myiasis. Removal of the maggot, instilling ototopical antibiotics admixed with aural antiseptics, systemic antibiotics and close follow up for meticulous aural toilet remains the main stay in management of aural myiasis.</p>

High prevalence of cesarean section delivery among health facilities delivered mothers in Bahir Dar city, Amhara region, Ethiopia. A comparative study

Background Cesarean section delivery prevalence rate has been in an alarming increase worldwide each year; there are large disparities of CS proportion among women who give birth at a public and private health facility. However, there is a lack of evidence regarding the underlying factors and the proportion of CS delivery in public and private health facilities. Therefore this study aimed to asses and compare the prevalence of CS delivery and associated factors among public and private health facilities delivered mother in Bahir Dar city, Amhara region, Ethiopia, Methods An institution-based comparative cross-sectional study design was conducted from March1-April 15, 2019 health facility in Bahir Dar city. Study participants 724(362 for each public and private facility) were recruited through a systematic random sampling technique. Structured interview administered questionnaires and chart review checklist were used to collect data. The data were entered with Epi info version 7.2 and analyzed using SPSS version 23.0 software. A binary logistic regression model was fitted and an adjusted odds ration with 95% CI was used to determine the presence and strength of association between independent variables and cesarean section delivery. Results The response rate was 98.3% and 97.2% for public and private health facilities respectively. The prevalence of CS in private health facilities was198 (56.3%) (95%CI: 50.9, 61.4) and 98 (27.5%) (95%CI: 22.8, 32.2) was in public health facilities. Overall prevalence of CS delivery was 296(41.8%) (95% CI: 38.4, 45.5). Breech presentation (AOR=3.64; 95%CI (1.49, 8.89), urban residence (AOR=6.54; 95%CI (2.59, 16.48) and being referred (AOR=2.44; 95%CI (1.46, 4.08)were variables significantly associated with CS among public facility whereas age between 15-24 (AOR=0.20, 95% CI; 0.07,0.52),governmental employee (AOR=2.28;95%CI (1.39,3.75),self-employed (AOR=3.73;95%CI(1.62,8.59),Para one(AOR=6.79;95%CI(2.02,22.79) Para two (AOR=3.88;95% CI(1.15,13.08), and wealth index being highest level of wealth asset AOR=5.39; 95%CI (1.08, 26.8) in private health facility: Conclusion and recommendation We concluded that there is a statistically significant difference in the prevalence of CS delivery in public and private health facilities. Therefore, there should be a mechanism for a medical audit of labor management.

Preference for Private Sector for Vaccination of Under-Five Children in India and Its Associated Factors: Findings from a Nationally Representative Sample

Background Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public–private partnership (PPP) model. Methods We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015–16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Results Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7–10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. Conclusion Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.