ABSTRACT
This cross-sectional study aimed to estimate the prevalence of appropriate antimicrobial prescribing for treating childhood diarrhea within the public hospital system in a central region province, Thailand. Reported are findings of a prospective clinical audit of 424 cases treated by 38 physicians. Appropriate use of antimicrobials was defined as prescribing antimicrobials for managing an invasive bacterial-type, bloody diarrhea or not prescribing antimicrobials for managing a watery-type or non-bloody diarrhea. Among 424 cases with diarrhea, 12.5% were invasive bacterial-type. Of the 66 diarrheal episodes in which stool samples were cultured, 7 stool specimens were positive, two with Shigella sonnei, two with Vibrio cholerae Ogawa and three with E. coli. Based on the presence of mucus and blood in stools, 27.4% of 424 cases received appropriate antimicrobial drugs. Cotrimoxazole was the most commonly prescribed drug (51%), followed by colistin sulfate (15.3%), norfloxacin (11%), and nalidixic acid (0.5%). The average number of antimicrobials per case of inpatients was higher than outpatients (1.15 vs 0.84, p < 0.001). There was a trend toward prescribing norfloxacin in childhood diarrhea. The Ministry of Public Health should continue providing effective interventions aimed at improving physicians' knowledge of diarrhea treatment. Similar efforts should be directed toward improving caretakers' knowledge about home care for childhood diarrhea and encouraging widespread correct use of oral rehydration therapy (ORT) in the community. Hopefully, such activities will help reduce the inappropriate use of antimicrobial agents in treating diarrheal disease.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Child, Preschool , Confidence Intervals , Cross-Sectional Studies , Diarrhea/drug therapy , Diarrhea, Infantile/diagnosis , Drug Utilization , Feces/microbiology , Female , Fluid Therapy/methods , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Hospitals, Public , Humans , Infant , Infant, Newborn , Male , Practice Patterns, Physicians' , Probability , Prospective Studies , ThailandABSTRACT
Despite substantial increases in immunization rates, measles remains a major health problem in developing countries of Southeast Asia. The authors of this paper undertook separate investigations which examined factors influencing measles immunization acceptance in the rural Philippines, Central Java, Indonesia, and an impoverished neighborhood in Bangkok, Thailand. We briefly summarize the findings of our three field investigations before presenting a synthesizing analysis of the psychosocial and demographic factors which affect measles immunization. We then review trends influencing measles acceptance in industrialized countries to anticipate possible future challenges to measles immunization acceptance in Southeast Asia in an era of increasing globalization and information transfer. We suggest that parental perceptions of the risks and benefits of immunization, philosophical and religious convictions and state and social regulatory policies will profoundly influence measles immunization in the new millennium.
Subject(s)
Asia, Southeastern/epidemiology , Humans , Immunization Programs/statistics & numerical data , Measles/epidemiology , Measles Vaccine/supply & distribution , Patient Acceptance of Health CareABSTRACT
A non-randomized control trial was conducted to develop and evaluate a culturally appropriate academic detailing intervention on the universal precautions knowledge, attitude and behavior of health care workers in hospitals. Fivety-five health care workers (44 nurses and 11 doctors) participated in the study. They were visited individually to discuss principles of universal precautions as well as the effect of automatic pilot on their work practices. Self-reported measures of knowledge and attitudes were collected from each participant before and after the intervention. A nurse observer collected measures of participants' compliance with the universal precautions guidelines according to a pre-determined protocol before and after the intervention. There was a significantly different level of knowledge, attitudes and compliance on universal precautions between the control and intervention hospital with p=0.0007, p=0.038 and p=0.03 respectively following the intervention. It is concluded that an academic detailing approach of education used in this study has significantly improved knowledge, attitudes and compliance scores.
Subject(s)
Health Knowledge, Attitudes, Practice , Humans , Indonesia , Inservice Training , Medical Staff, Hospital/education , Nursing Staff, Hospital/education , Universal PrecautionsABSTRACT
The ability to critically appraise literature is an essential skill for clinicians adopting a population perspective. Conventions exist for reporting and evaluating the quality of quantitative and epidemiological research. The same traditions do not exist in qualitative research for a number of reasons including the number of theories under which this type of research can be conducted and the subsequent incompatibility of indicators of quality. This paper presents a 10-point checklist for assessing the quality of qualitative research in clinical epidemiological studies. We aim to provide a framework for critical appraisal as well as offer direction for qualitative researchers in designing and publishing their work.