ABSTRACT
WHO suggest that family physician is the core in the world efforts for quality improvement, cost effectiveness, and equity in the health care systems. This study evaluates the impact of the program on accessibility of the services, case finding, patient referral, feedback process and insurance coverage in the rural health units. This study was quasi experimental. It compared the function of four health centers and eight health houses in the last three months of year 2004 with 2008. Data extracted from the available documents in the health units. Descriptive and analytical analysis was performed by using SPSS software. The presence of physicians in health centers were 75 and 100 percent for 2004 and 2008 respectively, this rate for midwives were 50 and 100 percent for the same years respectively. The total referral cases to the hospitals were 2676, the feedback rate was recorded in 36% of the cases. In this case the follow up rate by physicians was 0% in 2004 and 3.17% in 2008. Insurance coverage rate was 27% and 97% for 2004 and 2008 respectively within a meaningful P value range at 95% CI. The findings of this study show that the family physician program has the positive impact on function of health units in terms of availability of physicians and midwives and also insurance coverage at health centers in rural area. No impact on patient follow up and case referral rate was detected
ABSTRACT
Breastfeeding is proved to be both important and useful for children, mothers and community. To assess the breastfeeding problems and also mothers' expectations of their husbands, work places and health centers. This was across-sectional study carried out on 288 mothers with a two-year old child in 2004. The data were collected using a questionnaire and analyzed by K[2] test, statistically. Of a total of 288 mothers, 45.2% were illiterate or poorly literate and only 9% with education at university level. Most mothers [86.1%] were housewives and the rest with a job. Nearly half of the children were exclusively breastfed for six months and in total, 80% with breastfeeding duration of 22-23 months. There was a significant correlation between literacy and the duration of breastfeeding. A negative relationship was shown between breastfeeding duration and having a job. The important causes for terminating breastfeeding were mother's belief towards the sufficiency of breastfeeding [18.9%], lack of milk in mother's breasts [18.9%], and Child's avoidance [17%]. Approximately, 30.3% of mothers were found with no support from their husbands. Full supports by health centers were given only to 39.7% of mothers whereas 57.1% recevied relative supports. There was a positive correlation between the degree of support and the duration of breastfeeding. Among the mothers, 43.6% expected cooperation from their husbands and 68.8% of mothers with a job, insisted on extension of pregnancy leave. Also, 18.2% of mothers expected more proper behavior from the health center personnel. Regarding the data found in present study the most important causes of early breastfeeding termination were mother's mentality, lack of milk, and child's avoidance. It seems that good consultation could provide mothers with increased self-reliance. Additionally, the extension of pregnancy leave and also educating fathers on the quality of support given to mothers are recommended