We observed that 59% centers had staining facilities at the center. In 99% centers they had medicine
available all the time. 76% patients stated that the distance between centers and their residences is <1 kilometer. 97%
centers had accessible road to the centers. 76% providers knew consequences of treatment failure. 31% patients knew
the mode of transmission. 1% patients knew the duration of treatment. 73% patients knew consequences of treatment
failure.
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Authors: Kuan Pei Xuan1,2, Kuldip Kaur Prem Singh3, Law Kian Boon1, Mohd Aizuddin Abdul Rahman1,2, Mohan Dass Pathmanathan1,2, Wong Xin Ci1, Kalaiarasu M. Peariasamy1,2, Goh Pik Pin1
1 Digital Health Research and Innovation, Institute for Clinical Research, Malaysia
2 Clinical Research Centre, Hospital Sungai Buloh, Malaysia
3 Director Office, Hospital Sungai Buloh, Malaysia
https://doi.org/10.5281/zenodo.4004360
Introduction: The patient’s perception of quality of care is fundamental to utilization of health services. Health utilization would partly depend on clients’ perception of the quality of care.
Methods: A cross-sectional study involving health clients (18 to 70 years) who accessed health services in the Bantama submetro
in the Kumasi metropolis was conducted. A total of 400 clients were recruited from ten health facilities for the study.
Data was collected through interviewing using semi-structured questionnaires using SPSS and analyzed into descriptive and
inferential statistics with STATA 11.
Results: Majority of subscribers assessed healthcare with their National Health Insurance (NHI) cards. Eight percent (8%) had
never accessed healthcare with their NHIS cards. Respondents’ reasons included not falling sick and low quality of healthcare
under the NHIS. Respondents 216 (54%) indicated delays in seeing a doctor, getting laboratories done, and accessing health care as a whole. Seventy-four percent (74%) of the entire population attributed both NHIS and cash and carry systems as the
payment methods associated with delays in health facilities. Clients who viewed the overall the quality of health provision as good or very good were more likely to access healthcare with NHIS card as compared to those who rated the overall health provision as poor or very poor (OR=2.1; p<0.01).
Conclusion: Clients’ perceptions and experiences with quality of health provision influence their utilization of healthcare under the NHIS scheme. Increased enrolment in the scheme should be supported with provision of quality services to enhance clients’ satisfaction.
Lady health workers' perceptions towards tuberculosis and its determinants at...Zubia Qureshi
Background: Lady Health Workers (LHWs), performing in Tuberculosis control programs have direct access in the communities. This study was designed to improve the TB status in Sindh province by improving the knowledge and practices of LHWs. Objective: To assess the TB related knowledge, attitude and practices among LHWs at tehsil Latifabad, district Hyderabad, Sindh. Method: A mixed method Cross-sectional study was done on universally selected 384 LHWs from Latifabad. Three focus group discussions were conducted with eight participants for each group. A pre-tested structured questionnaire and eld guidelines were used for data collection. Analysis was done on SPSS software by calculating frequencies, percentages, mean and median. While for inferential analysis chi square, t-test and Mann Whitney U tests were used. For FGDs, content analysis method was used. Results: Sufcient knowledge was found in about half 193(50.3%) of the participants. The overall attitude and practices of most of the LHWs 214(55.7%) and 205 (53.4%) respectively was not good. A signicant difference was found between LHWs knowledge score of those who had insufcient (28.08 ± 3.0) and sufcient knowledge (28.08 ± 3.1) with p-value <0.001. Also good attitude (47.74±2.8) and practices (51.45±3.8) of LHWs differed signicantly from those who did not have good attitude (36.09±4.8), and practices (40.44±3.3) with p-value <0.001. The insufcient knowledge was associated with unsafe practices. Tuberculosis related stigma was found in the community, people do not want to disclose their disease. Conclusion: Overall knowledge, attitude and practices about TB were not satisfactory among LHWs of Latifabad. An educational intervention is recommended for LHWs. Key words: Community health workers, infectious disease, knowledge, attitude, practices, developing country
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Add...Clinical Tools, Inc
Tanner B, Metcalf F. A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Addiction with Buprenorphine. Poster presented at the 2015 IPS: The Mental Health Services Conference, October 10, 2015, New York, NY.
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Authors: Kuan Pei Xuan1,2, Kuldip Kaur Prem Singh3, Law Kian Boon1, Mohd Aizuddin Abdul Rahman1,2, Mohan Dass Pathmanathan1,2, Wong Xin Ci1, Kalaiarasu M. Peariasamy1,2, Goh Pik Pin1
1 Digital Health Research and Innovation, Institute for Clinical Research, Malaysia
2 Clinical Research Centre, Hospital Sungai Buloh, Malaysia
3 Director Office, Hospital Sungai Buloh, Malaysia
https://doi.org/10.5281/zenodo.4004360
Introduction: The patient’s perception of quality of care is fundamental to utilization of health services. Health utilization would partly depend on clients’ perception of the quality of care.
Methods: A cross-sectional study involving health clients (18 to 70 years) who accessed health services in the Bantama submetro
in the Kumasi metropolis was conducted. A total of 400 clients were recruited from ten health facilities for the study.
Data was collected through interviewing using semi-structured questionnaires using SPSS and analyzed into descriptive and
inferential statistics with STATA 11.
Results: Majority of subscribers assessed healthcare with their National Health Insurance (NHI) cards. Eight percent (8%) had
never accessed healthcare with their NHIS cards. Respondents’ reasons included not falling sick and low quality of healthcare
under the NHIS. Respondents 216 (54%) indicated delays in seeing a doctor, getting laboratories done, and accessing health care as a whole. Seventy-four percent (74%) of the entire population attributed both NHIS and cash and carry systems as the
payment methods associated with delays in health facilities. Clients who viewed the overall the quality of health provision as good or very good were more likely to access healthcare with NHIS card as compared to those who rated the overall health provision as poor or very poor (OR=2.1; p<0.01).
Conclusion: Clients’ perceptions and experiences with quality of health provision influence their utilization of healthcare under the NHIS scheme. Increased enrolment in the scheme should be supported with provision of quality services to enhance clients’ satisfaction.
Lady health workers' perceptions towards tuberculosis and its determinants at...Zubia Qureshi
Background: Lady Health Workers (LHWs), performing in Tuberculosis control programs have direct access in the communities. This study was designed to improve the TB status in Sindh province by improving the knowledge and practices of LHWs. Objective: To assess the TB related knowledge, attitude and practices among LHWs at tehsil Latifabad, district Hyderabad, Sindh. Method: A mixed method Cross-sectional study was done on universally selected 384 LHWs from Latifabad. Three focus group discussions were conducted with eight participants for each group. A pre-tested structured questionnaire and eld guidelines were used for data collection. Analysis was done on SPSS software by calculating frequencies, percentages, mean and median. While for inferential analysis chi square, t-test and Mann Whitney U tests were used. For FGDs, content analysis method was used. Results: Sufcient knowledge was found in about half 193(50.3%) of the participants. The overall attitude and practices of most of the LHWs 214(55.7%) and 205 (53.4%) respectively was not good. A signicant difference was found between LHWs knowledge score of those who had insufcient (28.08 ± 3.0) and sufcient knowledge (28.08 ± 3.1) with p-value <0.001. Also good attitude (47.74±2.8) and practices (51.45±3.8) of LHWs differed signicantly from those who did not have good attitude (36.09±4.8), and practices (40.44±3.3) with p-value <0.001. The insufcient knowledge was associated with unsafe practices. Tuberculosis related stigma was found in the community, people do not want to disclose their disease. Conclusion: Overall knowledge, attitude and practices about TB were not satisfactory among LHWs of Latifabad. An educational intervention is recommended for LHWs. Key words: Community health workers, infectious disease, knowledge, attitude, practices, developing country
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Add...Clinical Tools, Inc
Tanner B, Metcalf F. A Tool to Engage the Patient in Web-based Coordinated Treatment of Opioid Addiction with Buprenorphine. Poster presented at the 2015 IPS: The Mental Health Services Conference, October 10, 2015, New York, NY.
Background:
World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Field’s staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Field’s staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Field’s staining techniques in order to inform malaria diagnosis policy and practice in Uganda.
Methods:
This was a cross sectional cost effectiveness analysis from the provider’s perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Field’s staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in Tree Age was used for the cost effectiveness analysis.
Results:
Field’s and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Field’s and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Field’s and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case.
Conclusion:
Field’s staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Field’s staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.
Nursing Care Journal is interested in the special fields related to the topics of this Journal. Nursing care Journal discusses the latest research innovations and important developments in this field. Our target audience, readers and contributors are worldwide. Nursing and Health Care is an open access journal with rapid publication process, high quality manuscripts with innovative research which covers all the aspects of Nursing and Health Care. This Journal accepts original Research Articles, Review Articles, Case Reports, Mini Reviews, Rapid Communication, Opinions and Editorials on all the topics of nursing and health care.
Evaluation of the TB-HIV Integration Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-impact-of-a-social-support-strategy-on-treatment-outcomes/.
Homeopathic treatment of elderly patients - a prospective observational study...home
The severity of disease showed marked and sustained improvements under homeopathic treatment,
but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical
therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on
comparative effectiveness are needed to evaluate this hypothesis.
Household Catastrophic Health Expenditure From Oral Potentially Malignant Disorders And Oral Cancer In Public Healthcare Of Malaysia
Presentation Slides by Mr Sivaraj Raman, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348498
E-Poster: https://zenodo.org/record/5348963
Homeopathy – what are the active ingredients? An exploratory study using the ...home
This study has has identified, using primary consultation and other data, a range of
factors that might account for the effectiveness of homeopathic care. Some of these, such as
empathy, are non-specific. Others, such as the remedy matching process, are specific to
homeopathy. These findings counsel against the use of placebo-controlled RCT designs in which
both arms would potentially be receiving specific active ingredients. Future research in homeopathy
should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs
such as patient "openness", disclosure and homeopathicity.
A study on patient satisfaction with special reference to government hospital...Tapasya123
In this study researchers analyse the satisfaction level of patients regard to facilities
available in government hospitals. A sample of 100 patients is taken from Pandit Brij
Sundar Shama Government General Hospital (GGH) at Bundi District in the state
of Rajasthan in India. Four dimensions of perceived quality were identified—Admission
Procedure, Diagnostic Services, Behaviour of the staff, Cleanliness. The developed
scale is used to evaluate perceived quality at a range of various types of facilities
for patients. Perceived quality at public facilities is only marginally favourable, leaving
much scope for improvement. Better staff and physician relations, interpersonal skills,
good diagnostic and cleanliness service can improve the level of satisfaction among
employees.
Keywords:
What do clinicians want? Interest in integrative health services at a North C...home
There is strong interest among medical staff at an academic health center in
comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness,
nutrition and stress management. Future studies will need to assess the cost-effectiveness of such
services, as well as their financial sustainability and impact on patient satisfaction, health and quality
of life.
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
With the increase of tuberculosis patients in India that constantly need visits to medical centers almost 40 times in the course of 6 months. Microsoft explores the role of a biometric attendance terminal in persuading patients to complete follow-up health visits in slum communities of New Delhi, India.
Background:
World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Field’s staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Field’s staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Field’s staining techniques in order to inform malaria diagnosis policy and practice in Uganda.
Methods:
This was a cross sectional cost effectiveness analysis from the provider’s perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Field’s staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in Tree Age was used for the cost effectiveness analysis.
Results:
Field’s and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Field’s and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Field’s and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case.
Conclusion:
Field’s staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Field’s staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.
Nursing Care Journal is interested in the special fields related to the topics of this Journal. Nursing care Journal discusses the latest research innovations and important developments in this field. Our target audience, readers and contributors are worldwide. Nursing and Health Care is an open access journal with rapid publication process, high quality manuscripts with innovative research which covers all the aspects of Nursing and Health Care. This Journal accepts original Research Articles, Review Articles, Case Reports, Mini Reviews, Rapid Communication, Opinions and Editorials on all the topics of nursing and health care.
Evaluation of the TB-HIV Integration Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-impact-of-a-social-support-strategy-on-treatment-outcomes/.
Homeopathic treatment of elderly patients - a prospective observational study...home
The severity of disease showed marked and sustained improvements under homeopathic treatment,
but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical
therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on
comparative effectiveness are needed to evaluate this hypothesis.
Household Catastrophic Health Expenditure From Oral Potentially Malignant Disorders And Oral Cancer In Public Healthcare Of Malaysia
Presentation Slides by Mr Sivaraj Raman, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348498
E-Poster: https://zenodo.org/record/5348963
Homeopathy – what are the active ingredients? An exploratory study using the ...home
This study has has identified, using primary consultation and other data, a range of
factors that might account for the effectiveness of homeopathic care. Some of these, such as
empathy, are non-specific. Others, such as the remedy matching process, are specific to
homeopathy. These findings counsel against the use of placebo-controlled RCT designs in which
both arms would potentially be receiving specific active ingredients. Future research in homeopathy
should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs
such as patient "openness", disclosure and homeopathicity.
A study on patient satisfaction with special reference to government hospital...Tapasya123
In this study researchers analyse the satisfaction level of patients regard to facilities
available in government hospitals. A sample of 100 patients is taken from Pandit Brij
Sundar Shama Government General Hospital (GGH) at Bundi District in the state
of Rajasthan in India. Four dimensions of perceived quality were identified—Admission
Procedure, Diagnostic Services, Behaviour of the staff, Cleanliness. The developed
scale is used to evaluate perceived quality at a range of various types of facilities
for patients. Perceived quality at public facilities is only marginally favourable, leaving
much scope for improvement. Better staff and physician relations, interpersonal skills,
good diagnostic and cleanliness service can improve the level of satisfaction among
employees.
Keywords:
What do clinicians want? Interest in integrative health services at a North C...home
There is strong interest among medical staff at an academic health center in
comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness,
nutrition and stress management. Future studies will need to assess the cost-effectiveness of such
services, as well as their financial sustainability and impact on patient satisfaction, health and quality
of life.
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
With the increase of tuberculosis patients in India that constantly need visits to medical centers almost 40 times in the course of 6 months. Microsoft explores the role of a biometric attendance terminal in persuading patients to complete follow-up health visits in slum communities of New Delhi, India.
This ppt contains all the information about Revised NationalTuberculosis Control programme (RNTCP) It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Annette Verster, WHO
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Interventions to change providers' practice in cameroon h hopkinsACT Consortium
Presentation by Heidi Hopkins
Cross-cutting analysis Lead, ACT Consortium
Senior Lecturer in Malaria & Diagnostics at London School of Hygiene & Tropical Medicine
Similar to Evaluation ofquality-of-care-in-dots-centers-under-nationaltuberculosis-control-program-in-dhaka-city (20)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
2. Citation: Bulbul T (2017) Evaluation of Quality of Care in DOTs Centers under National Tuberculosis Control Program in Dhaka City. J Tuberc Ther 1: 107.
Page 2 of 6
Volume 2 • Issue 1 • 1000107
J Tuberc Ther, an open access journal
Materials and Methods
We assessed quality of care in DOTs under TB control programme
in Dhaka city, operated by four organizations BRAC, UPHCP, SSFP
and the Government. We collected data from February to May 2014.
We employed a team of 12 field workers with a field coordinator
for data collection and supervision. Pretested questionnaires were
employed to interview the study participants. The protocol of the study
had been approved by the Institutional Review Board, BRAC prior to
the study. Informed written consent was taken from each selected study
participants. For providers’ perspectives the field team interviewed
92 health workers from selected 92 centers from a population of 135
centers, calculated through finite population corrected sample size. For
patients’ perspectives the field team interviewed randomly selected 357
patients who were under DOTs from the selected centers. We selected
4 patients from each selected center. In this study the caregivers are the
primary health workers who delivers medicine to the patients. Almost
all four organizations deliver medicine through trained health workers
at the center. In few cases they have provision to deliver the medicine
at patient’s place.
Under five broad headings (a) care by practitioners, (b) knowledge,
(c) interpersonal relations, amenities, (d) care implemented by
patients and (e) care implemented by communities) the frequency
for each indicators from both caregivers’ and patients’ perspectives
were calculated. Regression analysis was done to see the differences in
caregivers’ perspectives among organizations. We analyzed data using
Stata. We assessed the quality of care in three levels, structure, process
and outcomes of the care relating to both the patients’ and providers’
perspectives in each level [5].
Results
We collected data from 92 caregivers from selected 92 DOTs centers
and from 357 patients from those centers. The field workers obtained
information from the patients and caregivers regarding 1) care by
care givers which includes the facilities within the centers, presence
of equipment and extent of monitory involvement at participatory
level, 2) knowledge of TB transmission and treatment, 3) interpersonal
relation during receiving and giving the treatment, 4) Amenities include
convenience, comfort and privacy, 5) Care implemented by patients
includes indicators for treatment outcomes and those that contribute
to treatment outcomes. 6) Care implemented by communities includes
indicators for access to care.
Care by caregivers
According to care givers’ statements, 59% DOTs centers had
staining facilities at the center, and all centers that had staining
facilities, had a separate room for staining. In 99% DOTs centers,
medicine was available all the time, in 98% DOTs centers they had a
separate place for TB medicine. In 84% DOTs centers, they had waiting
room for the patients. In 90% DOTs centers, they had waste baskets
at the center. Among organizations, there is significant difference in
having a waiting room for the patients and waste baskets at the center
(p<0.05). However, there is no significant difference in having staining
facilities, separate room for staining, separate place for TB medicine
and in availability of medicine at the center among the organizations.
In 8% DOTs centers, they had own X-ray facilities.
According to patients’ statements, 47% patients’ sputum tests were
performed at the DOTs centers and 46% were diagnosed as TB cases at
the DOTs centers.
According to care givers’ statements, 8% DOTs centers charged
fees for initial visit and in 2% centers charged fees for each visit.
None of these centers charged for medicine. According to patients’
statements, 4% patients paid for initial visit. None of the patients paid
for TB medicine (Tables 1 and 2).
Knowledge
Ninety three percent caregivers knew the mode of transmission
of pulmonary tuberculosis. Ninety nine percent caregivers knew
the duration of the treatment. Forty percent caregivers knew the
consequences of treatment. Seventy six percent caregivers knew
consequences of treatment failure. Thirty one percent patients knew
the mode of transmission. One percent patients knew the duration
of treatment. Ninety eight percent patients knew the consequences
of treatment. Seventy three percent patients knew consequences of
treatment failure. However, among the organizations, there is no
significant difference in knowledge of TB transmission and treatment
among the caregivers (Tables 3 and 4).
Interpersonal relations
While treating patients, caregivers did not face any problem dealing
with patients. However, in 67% centers, caregivers stated that patients
can complain regarding the courses and duration of treatment. There
is no significant difference in caregivers’ statements regarding patients’
rights among the organizations. According to patients’ statements,
20% patients had complaints against the duration of the treatment.
All patients stated that caregivers spent sufficient time while treating
(Tables 5 and 6).
Amenities
Regarding convenience, the distance of DOTs centers from the
patients’ residences was asked. Seventy two percent caregivers stated
that patients’ residences were more than a kilometer from the centers.
There is no significant difference in care givers statements regarding
distance between the centers and residences among the organizations.
Indicators n/N %
Facilities
Caregivers’ statements
Had staining facilities* 54/92 59
Had a separate room for staining* 54/92 59
TB medicine was available all the time 91/92 99
Had a separate place for TB medicine* 90/92 98
Maintains chart for dose schedule 90/92 98
Had a waiting room for patients* 77/92 84
Had waste baskets at the center* 83/92 90
Patients’ statements
Sputum test was performed at the DOTs centers 168/357 47
Diagnosed as TB at the DOTs center 166/357 46
Equipment
Center had own X-ray facilities* 7/92 8
Money
Caregivers’ statements
Patient needs to pay for the 1st visit 7/92 8
Patient needs to pay for each visit 2/92 2
Patient needs to pay for TB medicine 0/92 0
Patients’ statements
Patient needs to pay for the 1st visit 16/357 4
Patient needs to pay for each visit 0/357 0
Patient needs to pay for TB medicine 0/357 0
*data were collected from spot check as well
Table 1: Care by caregivers.
3. Citation: Bulbul T (2017) Evaluation of Quality of Care in DOTs Centers under National Tuberculosis Control Program in Dhaka City. J Tuberc Ther 1: 107.
Page 3 of 6
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Indicators
BRAC UPHCP SSFP Government p-value
n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Had staining facilities* 17 65 15 43 16 67 6 86 0.36
Had a separate room for staining* 17 65 14 40 17 71 6 86 0.252
Had a separate place for TB medicine* 25 96 35 100 24 100 6 86 0.567
Maintains chart for dose schedule* 26 100 34 100 24 100 6 86 0.204
Had a waiting room for the patients* 16 61 33 94 23 96 5 71 0.037
Had waste baskets at the center* 18 69 35 100 24 100 6 86 0.013
Patient needs to pay for the 1st visit 1 4 2 6 2 8 2 29 0.09
Patient needs to pay for each visit 0 0 1 3 1 4 0 0 0.567
*data were collected from spot check as well
Table 2: Care by caregivers in different organizations.
Indicators n/N %
Caregivers’ statements
Knew mode of transmission 86/92 93
Knew duration of treatment 91/92 99
Knew consequences of treatment 37/92 40
Knew consequences of treatment failure 70/92 76
Patients’ statements
Knew mode of transmission 110/357 31
Knew duration of treatment 5/357 1
Knew consequences of treatment 351/357 98
Knew consequences of treatment failure 260/357 73
Indicators n/N %
Caregivers’ statements
Knew mode of transmission 86/92 93
Knew duration of treatment 91/92 99
Knew consequences of treatment 37/92 40
Knew consequences of treatment failure 70/92 76
Patients’ statements
Knew mode of transmission 110/357 31
Knew duration of treatment 5/357 1
Knew consequences of treatment 351/357 98
Knew consequences of treatment failure 260/357 73
Table 3: Knowledge.
Indicators
BRAC UPHCP SSFP Government p-value
n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Mode of transmission 24 92 34 97 21 88 7 100 0.92
Duration of treatment 26 100 34 97 24 100 7 100 0.886
Consequences of treatment 8 31 15 43 12 50 2 29 0.46
Consequences of treatment failure 22 85 25 71 18 75 5 71 0.403
Table 4: Knowledge of the caregivers in different organizations.
Indicators n/N %
Caregivers’ statements
Faced problem while treating patients 0/92 0
Patients can complain about the treatment courses 62/92 67
Patients’ statements
Complained about duration of treatment 73/357 20
Caregivers spent sufficient time 357/357 100
Table 5: Interpersonal relations.
Indicators BRAC UPHCP SSFP Government p-value
n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Faced problem while treating patients 0 0 0 0 0 0 0 0 ____
Patients can complain about the treatment courses 15 58 26 74 17 71 4 57 0.641
Table 6: Interpersonal relations in different organizations.
4. Citation: Bulbul T (2017) Evaluation of Quality of Care in DOTs Centers under National Tuberculosis Control Program in Dhaka City. J Tuberc Ther 1: 107.
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However, 76% patients stated that the distance between the centers and
their residences is less than a kilometer. Seventy seven percent patients
stated that they got medicine at their convenient time. Ninety nine
percent patients stated that they used to take medicine regularly.
Regarding comfort, in 89% cases, caregivers stated that they could
take a day off whenever they required. In 91% cases caregivers could
deliver their job to other co-workers if required. However, there is
no significant difference in caregivers’ statements on job satisfaction
among organizations. Forty three percent patients stated that they were
comfortable in taking medicine at their home. Seventy five percent
patients stated that they had complaints on drugs.
Regarding privacy, 100% caregivers claimed that they see patients
separately, and 86% caregivers claimed that they maintain secrecy
of patients’ information. However, there is no significant difference
in caregivers’ statements on maintaining patients’ secrecy among
organizations. Ninety four percent patients stated that they received
medicine separately. Ninety four percent patients think that their
personal information was kept secret (Tables 7 and 8).
Care implemented by patients
Eighty five percent providers thought that patients can follow the
treatment guidelines. There is no significant difference in caregivers’
statements regarding following the treatment guidelines by the care
givers among organizations. However, there is significant difference
in following treatment guidelines by the patients among organizations
(p<0.05). None of the patients complained about the duration that was
spent by the caregivers during treatment. All the patients thought that
caregivers properly informed them regarding taking medicine and the
date and time of following visit. Fifteen percent patients stated that they
could change their visiting time if required.
Last one year’s patient’s record showed that on average 73 (57
to 89) patients were cured who received DOTs, 78 (60 to 94) patients
completed therapy and among them 3(1 to 4) cases relapsed.
One percent of the patients stated that during the course of
treatment they failed to maintain the schedule for DOTs. Twelve
percent patients who were currently under DOTs had previous history
of TB and among them 98% patients had taken medicines for TB.
However, among those who received DOTs before, 60% completed the
course (Tables 9 and 10).
Care implemented by communities
Ninety seven percent centers had accessibility to public transport.
Among organizations, there is significant difference in having
Indicators n/N %
Convenience
Caregivers’ statements
Patients come from within 1 Km 24/92 26
Patients come from more than 1 Km 66/92 72
Patients’ statements
Patients come from within 1 Km 273/357 76
Patients come from more than 1 Km 83/357 83
Patients get medicine at their convenient time 274/357 77
Patients take medicine regularly 352/357 99
Comfort
Caregivers’ statements
Can take a day off whenever required 82/92 89
Can deliver the work if required 84/92 91
Patients’ statements
Comfortable in taking medicine at the center 155/357 43
Want to take medicine at their home 188/357 53
Face problem with the medicine 269/357 75
Privacy
Caregivers’ statements
See the patients separately 92/92 100
Do not share information of one patient to another 79/92 86
Patients’ statements
See patients separately 334/357 94
Maintains secrecy about their information 335/357 94
Table 7: Amenities.
Indicators BRAC UPHCP SSFP Government p-value
Convenience n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Patients come from within 1 km 15 58 5 14 4 17 0 0 ___
Patients come from more than 1 km of distance 9 35 30 86 20 83 7 100 ___
Comfort
Caregivers can take day off whenever required 22 85 33 94 21 88 6 86 0.911
Caregivers can deliver their work if required 21 81 33 94 23 96 7 100 0.054
Privacy
See patients separately 26 100 35 100 24 100 7 100 _____
Do not share information of one patient to another 22 85 30 86 20 83 7 100 0.579
Table 8: Amenities in different organizations.
5. Citation: Bulbul T (2017) Evaluation of Quality of Care in DOTs Centers under National Tuberculosis Control Program in Dhaka City. J Tuberc Ther 1: 107.
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accessible road to the centers for public transportation. In 43% centers
patients even came from outside the catchment area of a particular
center. Among the organizations, there is significant difference in
centers receiving patients beyond their catchment area (p<0.05).
Twenty five percent providers said that the transportation cost to the
center from their residence was less expensive. Among organizations,
there is significant difference in expenditure for travelling to the
centers (p<0.05). Twelve percent centers had health workers to deliver
medicine at the patients’ place. Ninety nine percent centers had
capacity to store medicine (Tables 11 and 12).
Discussion
To draw inference, we divided the results under three broad
headings; structure, process and outcomes [5]. Structure denotes the
facilities that had been provided by the programme, process denotes
the patients’ and providers’ situation and action in the definite setup
and outcome denotes the effect from the programme.
Structure
Due to limited resources and lack of skilled technologists [6]
Indicators n/N %
Contribution of Caregivers
Caregivers’ statements
Follows the treatment guidelines 78/92 85
Patients’ statements
Spent sufficient time for patients 357/357 100
Caregivers explained the patients about proper way of taking medicine 357/357 100
Caregivers mentioned the patients about the date of next visit 357/357 100
Caregivers mentioned the patients about the exact time of next visit 357/357 100
Patients can change the visiting time if required 53/357 15
Treatment Outcomes
Cured* 73 (57-89) † _
Completed therapy* 78 (60-94) † _
Relapse * 3 (1-4) † _
Dropped visit 5/357 1
H/O previous TB 43/357 12
Taken medicine before 42/43 98
Completed the treatment course last time 25/42 60
*data were from last one year’s record, †calculated average
Table 9: Care implemented by patients.
Indicators BRAC UPHCP SSFP Government p-value
Contribution of caregivers n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Follows the treatment guidelines 20 77 33 94 20/24 83 5 71 0.956
Contribution of receivers
Follows the treatment guidelines 14 54 6 17 24-Mar 13 1 14 0.003
Table 10: Care implemented by patients in different organizations.
Indicators n/N %
Access to care*
Geographic
Have accessible road for public transportation 89/92 97
Patients come from outside the catchment area of the center 40/92 43
Economic
Less expensive to come to the center 23/92 25
Organizational
Health workers deliver the medicine at patients’ places Nov-92 12
Had provision to store medicine at the centers 91/92 99
*data were obtained from caregivers
Table 11: Care implemented by communities.
Indicators BRAC UPHCP SSFP Government
p-value
Geographic n/N=26 % n/N=35 % n/N=24 % n/N=7 %
Have accessible road for public transportation 14 54 6 17 3 13 1 14 0.003
Patients come from outside the catchment area 14 54 6 17 3 13 1 14 0.003
Economic
Less expensive to come to the centers 3 12 8 23 9 38 3 43 0.021
Organizational
Delivers medicine at patients’ places 2 8 5 14 3 13 1 14 0.582
Table 12: Care implemented by communities in different organizations.
6. Citation: Bulbul T (2017) Evaluation of Quality of Care in DOTs Centers under National Tuberculosis Control Program in Dhaka City. J Tuberc Ther 1: 107.
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J Tuberc Ther, an open access journal
nearly half of the centers had no staining facilities to confirm TB cases.
However, most of the centers ensured cleanliness and patients’ comfort,
which reduces the transmission of germ at healthcare facilities [7,8]. On
the contrary, only half of the centers ensured availability of medicine,
thus point of service at patients’ places through trained volunteers may
reduce the drop out cases [9]. Free DOTs services ensured completion
of therapy among all, irrespective of patients’ socioeconomic status
[10,11]. Even though very limited centers had X-ray facilities,
strong referral system had been maintained to confirm early detection
of positive and active cases [12].
Process
The DOTs centers were located near the enlisted patients’ residence
that reduces time and travel cost. However, patients are willing to take
medicine to their home to maintain regularity [13]. In spite of the
comfort of taking medicine to their home, in three out of four cases,
patients complained about the drugs [14]. To give more comfort to the
patients, patients are treated separately to minimize the psychosocial
trauma related to taboo regarding TB in the community [15,16].
Outcomes
Irrespective of poor knowledge of disease transmission, fate and the
duration of treatment among the patients, high treatment completion
rate proves effective approach of DOTs. Moreover, the centers’ records
showed very few relapse cases due to non-completion of course,
indicating effectiveness of directly observed therapy [17].
Conclusion
Strengthening of existing DOTs centers under TB control
programme by ensuring treatment and diagnostic facilities in all
the centers could be an approach for early diagnosis and treatment.
Additional approach to mass level of education on DOTs and TB
transmission would be introduced to improve knowledge. To reduce
the incidence of TB, DOTs centers might be equipped with vaccination
programme parallel to the existing EPI programme in Bangladesh.
Funding
Funded by Bangladesh Rural Advancement Committee (BRAC).
There is no role of the funding body in the study design, data collection,
data analysis, and interpretation of data and in writing the manuscript.
Acknowledgement
I would like to acknowledge M.R.Chowdhury, ED, RED, BRAC, Samir Ranjan
Nath, Programme Head education, RED, BRAC, and the entire field staff for their
support to conduct this study. I would like to especially acknowledge Mohiuiddin
Ahmad, researcher, for his intensive support and Raphael Ahmed for editing the
manuscript.
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