ABSTRACT
<p><b>Objectives</b></p><p> The aim of this study was to investigate the knowledge, attitude, and practice (KAP) of healthcare providers regarding the utilization of oxytocin for induction or augmentation of labor.</p><p><b>Methods</b></p><p> A qualitative study composed of direct observation and individual interview was conducted at a national tertiary maternity hospital in Phnom Penh, Cambodia in January and February 2013. The progress of labor in women who received oxytocin for induction or augmentation of labor was directly observed to confirm the healthcare providers’ management of oxytocin infusion. The attending doctors and midwives were individually interviewed after the women delivered. </p><p><b>Results</b></p><p> During the study period, 10 women were observed, and 12 healthcare providers (three doctors and nine midwives) were interviewed individually. Indications for labor induction or augmentation seemed to be appropriate for nine women. However, we found discrepancies between the national protocol and healthcare providers’ knowledge and actual practices. For example, 11 healthcare providers had never read the national protocol for the management of labor induction and augmentation, which implied limited access to the correct knowledge. A misconception was noted in that the sudden increase of oxytocin was not dangerous during the second stage of labor, despite the establishment of a good contraction pattern. Furthermore, a lack of unified initial dose and extremely high maximum dose above that recommended by the national protocol were observed. About half of observed women were not monitored for more than 2 hours from the beginning of oxytocin infusion.</p><p><b>Conclusion</b></p><p> In the present study, lack of knowledge, misconceptions regarding the management of oxytocin infusion, and a large gap between the national protocol and the actual clinical practices were confirmed. To maximize patient safety and therapeutic benefit, dissemination of the national protocol through in-service training is required.</p>
ABSTRACT
As part of the Pacific Program to Eliminate Lymphatic Filariasis (PacELF), baseline surveys were conducted in 1999 and 2004 in Nauru to determine the prevalence of filariasis by rapid immunochromatotraphic test (ICT). In 1999, the survey demonstrated a filariasis prevalence of 0.26%, and Nauru was classified as a non-endemic country at the time. In 2004, the prevalence resulting from the survey was 1.66%. Since it exceeded 1.0%, this high prevalence warranted the implementation of Mass Drug Administration (MDA) according to WHO guidelines and gave rise to an urgent need to re-establish the filariasis policy in Nauru, as the target year for filariasis elimination in the Pacific is 2010. The present study was conducted to determine the current prevalence of filariasis, to decide whether implementation of the MDA program is necessary, and to compare the demographic characteristics of participants according to the ICT test results. Blood sampling and interviews, based on a simple questionnaire asking about filariasis-related symptoms, were conducted by trained health staff members. A total of 1,513 people were enrolled for the survey in January 2007. Filariasis positivitiy was detected in three subjects (0.2%) by ICT test. Nauru was reconfirmed as a non-endemic country and therefore did not require the MDA implementation. The prevalence did not vary significantly according to the demographic characteristics. The three seropositive cases did not have any filariasis-related symptoms. However, two of the three positive cases of filariasis lived in the same district and the other lived in a neighboring district. To assess the interruption of filariasis transmission, further surveys are recommended.