Handicapping conditions among children under six years in family medicine centers in Alexandria. Part I: screening and detection

Early identification of children with developmental delays is important in the primary health care [PHC] setting. The PHC practitioner's office is mostly the place where the majority of children younger than 5 years of age are seen and is ideal for developmental and behavioral screening by the use of age-appropriate developmental checklists to record milestones during preventive care visits as a part of developmental surveillance. The aim of the present study was to screen children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt for the early detection of some handicapping conditions [visual, hearing, speech, and orthopedic] and to review the family files of the screened children to assess the number of suspicious cases missed by the family physicians. Data were collected using a pre-designed screening sheet for the early detection of the above mentioned handicapping conditions among 550 children attending the study FM facilities and by family file review of the screened children. Screening of children under 6 years old had yielded the following results: orthopedic abnormalities represented 14.2%, followed by visual abnormalities [9.3%], speech abnormalities [8.9%], hearing abnormalities [6.2%], and mental retardation [2%]. Risk factors found to affect the occurrence of the study handicapping conditions were found to be mostly positive family history, consanguinity between parents, maternal age at the time of pregnancy, and complications during pregnancy; labour; and in the post natal period. Recording was incomplete as only 11.6% of the screened children had both complete files including growth and development charts. Poor performance of the family physicians in the study facilities was evident regarding detection and referral of handicapped cases in children as only 75 handicapped cases [46.3%] could be detected by the family physicians in the study facilities out of the 162 handicapped cases detected by the researcher. Family physicians in the study facilities referred only 57.3% of the detected. Therefore, screening for risk factors of handicap should be performed by the family physicians during routine daily activity as well as during the well baby clinic schedules. This is best achieved by proper development and application of guidelines and protocols for screening, follow up, and management of handicapping conditions including proper recording and referral

Handicapping conditions among children under six years in family medicine centers in Alexandria. Part II: assessment of resources

Handicap means the disadvantage or restriction of activity caused by disability. It is the practical consequence of disability and impairment. It is estimated that 5% of the world's children population suffer from severe handicaps and an additional 10-15%, may need special attention to overcome less severe handicaps. The aim of the present study was to assess the quality of human and non-human resources necessary for the prevention and control of handicapping conditions among children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt. Data were collected using 2 different questionnaires: a checklist was designed to assess the availability of resources required for the early detection of visual, hearing, speech, and orthopedic causes of handicap among children under six in the study family medicine facilities. A self-administered questionnaire was designed to assess the knowledge, attitude, and practice [KAP] of 34 family physicians working in the study FM facilities about the early detection of the previously mentioned handicapping conditions in children. The percentage of registered to the total population was highest at Gohn FM unit [68.8%] and lowest at El-Seiouf FM center [24.6%]. Most of the equipment required for handicap screening was available in the study FM facilities. Child health records, daily registration records, and well baby clinic records were available, but no specific records or reports for handicapping conditions in children were present. About half of the physicians [47%] had no postgraduate studies at all, only 23.5% and 3% of the family physicians were trained about detection of mental retardation, and genetic causes of handicap, respectively and 14.7% did not attend any training course at all. The majority of family physicians had fair knowledge [76.5%], positive attitude [61.8%], and partial practice [70.6%]. The difference in KAP levels between the different study facilities was statistically insignificant. There was a statistically significant direct proportionate relation between the knowledge of the physicians and their practice; i.e., the higher is the knowledge the better is the practice. Therefore, handicap prevention and control should be properly integrated within PHC [Family medicine] services with continuous, proper training of all health team members

Quality assessment of primary health care services provided for diabetes mellitus control in Alexandria

The present study was conducted aiming at: assessment of the quality of primary health care [PHC] services provided for the control of diabetes mellitus [DM] in Alexandria; and opportunistic screening of high risk individuals attending PHC facilities for DM. Accordingly, the availability of human and non-human resources for DM control in two r h and two urban PHC centers in Alexandria [one of them was sewing a desert area] was assessed by a pre-designed checklist 920 adult PHC attendants were screened for risk factors of DM. Individuals having more than one of the following risk factors: age above 50 years, overweight [body mass index >27 kg/m2], family history of DM in first degree relatives, history of hypertension, hypertension [systolic blood pressure >140 mm Hg and /or diastolic blood pressure >90 mm Hg], history of hyperlipidemia and history of gestational diabetes or birth of a large sized baby in females- were subjected to random capillary blood glucose [RCBG] testing. Cases were considered likely diabetic if RCBG was >200 mg/dl. The performance of all PHC physicians examining and managing 560 diabetic patients was observed over a period of two months. One fourth of the diabetic cases were checked for the level of glycaemic control by fasting capillary blood glucose testing

role of primary health care in patient education for diabetes control

The aim of the present work was to study the role of primary health care [PHC] in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all PHC physicians [88] and nurses [104] working in 2 rural health centers and 2 randomly chosen urban health centers of Alexandria Governorate were assessed by a pre-designed self-administered questionnaire. All diabetic patients [560] over 20 years of age attending the study health facilities over a period of 2 months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. It may be concluded that there is a serious gap in the provision of basic education services to the majority of diabetic patients attending PHC facilities in Alexandria

Analysis of the constraints facing primary health care delivery in rural and urban areas

The purpose of the study was to study the constraints of PHC delivery in rural and urban PHC facilities in physician's point of view together with the observation visits of the researcher. The basic constraints encountered were in PHC principles, implementations supportive services, and management. Also the study revealed physicians work frustrations. From these results it could be concluded that firm commitment to district health system implementation for PHC supported by the health system together with collaboration of educational institutions in preparation and training of manpower in the context of PHC

Therole of primary health care in elderly care at rural areas

There is general agreement in the literature on the five areas that should be included in a total assessment of groups of the elderly. They are activities of daily living [ADL], mental health, physical health as well as social and economic functioning. However a cross sectional research was done in rural areas aiming at the assessment of health status of the elderly and PHC services provided to them as well as its rate of utilization. A modified multidimensional assessment questionnaire was used. The results revealed several risk factors that may raise the rate of dependence, undiagnosed disabilities, under utilization of the available PHC services and lacking of a program for caring of the elderly at PHC facilities. The study recommended a strategy for care of the elderly in the context of primary health care