Suchergebnisse

BACKGROUND: A majority of women in the Democratic Republic of the Congo (DRC) give birth in a health facility, but maternal and newborn mortality remains high. In rural areas, the quality of facility-based delivery care is often low. This study examines clinical quality of intrapartum care in two provinces of the DRC. METHODS: We observed process and input elements of delivery care provision at 29 facilities in Kwilu and Kwango provinces. Distinguishing non-performance attributable to provider behavior vs. input constraints, we compared both providers' adherence to clinical standards ("competent care") and non-adherence to processes for which required inputs were available ("deficient care"). RESULTS: Observing a total of 69 deliveries, care was most competent for partograph use (75% cases) and hemorrhage prevention (73%), but least for postpartum monitoring (4%). Competent care was significantly associated with higher case volumes (p = ·03), skilled birth attendance (p = ·05), and nulliparous women (p = ·02). Care was most deficient for infection prevention (62%) and timely care (49%) and associated with cases observed at hospitals and lower delivery volume. CONCLUSIONS: Low quality was commonly not a result of missing equipment or supplies but related to providers' non-adherence to standard protocols. Low case volumes and the absence of skilled attendants seemed to be main factors for sub-standard quality care. Birth assistance during labor stage 2 was the only intrapartum stage heavily affected by the unavailability of essential equipment. Future interventions should strengthen links between birth attendants' practice to clinical protocols.

Aim: To determine the correlation between urine sampling from different sites, including stones, and also to ascertain which is more predictive of urosepsis. Material and Methods: All patients undergoing PCNL in Government Medical College Hospital, Calicut during the period of one year (from March 2016 to February 2017) who fulfilled our selection criteria were recruited. The samples collected were 1) midstream urine and bladder urine at cystoscopy, 2) renal pelvic urine collected at the time of ureteric catheter insertion 3) renal pelvic urine collected at percutaneous puncture of the pelvicaliceal system and 4) stones which were extracted. The samples were sent immediately for C&S. Patients were monitored for systemic inflammatory response sysndrome (SIRS). Results: Total of 135 cases were suitable for analysis. Midstream urine C&S was positive in 9.63% of cases. Stone C&S was positive in 30.37% and pelvic C&S was positive in 20.74%. Pelvic urine C&S was a better predictor of infected stones than bladder urine C&S. Of the 135 patients 31.9% had SIRS and 4 patients experienced septic shock. Patients with infected stones or pelvic urine were found to be at a relative risk for urosepsis that was at least 10 times greater (p<0.0001). Bladder urine was not a good predictor of SIRS. Stone C&S had a positive predictive value of 0.7, which was the highest. Preoperative dilatation of pelvicalyceal system correlated with infected pelvic urine. None of the patients with urosepsis had positive blood C&S. Conclusions: Positive stone C&S and pelvic urine C&S are better predictors of urosepsis than bladder urine in our study. So, routine collection of pelvic urine and stone for culture and sensitivity is recommended.

BACKGROUND: Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala. MATERIALS AND METHODS: A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15–18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets. RESULTS: The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene. CONCLUSION: The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.

AbstractAccess to high‐quality family planning services remains limited in many low‐ and middle‐income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance‐based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty‐eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow‐up data collection took place in 2021–2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand‐side interventions are likely needed in a setting with very low baseline utilization.