Comparison of satisfaction with maternal health-care services using different health insurance schemes in aceh province, Indonesia.

Background: An insurance scheme called Jaminan Kesehatan Aceh (JKA) was established by the local government to achieve universal coverage for Aceh's population who were not registered under the national insurance scheme for the poor (Jamkesmas). Objective: This study was conducted to compare women's satisfaction before and after the implementation of JKA and across different insurance schemes. Methods: The study was conducted from July 2011 to July 2012 on satisfaction of maternal health services among 1197, 15-49 years aged old women living in eight districts of Aceh Province, Indonesia, and a cluster sampling technique was applied. Analysis of variance was used to assess the effects of different insurance schemes, period, and type of services on satisfaction with maternal health services. Results: Women were mostly satisfied with birth delivery services (mean score: 2.69) followed by postnatal care (mean score: 2.62) and antenatal care services (mean score: 2.37). Conclusion: Over the changing period, the average level of satisfaction in the JKA group increased significantly.

Association between Intraoperative and Post- Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand.

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand. Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9). Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

Comparison of Accessibility among Vision-impaired Patients Visiting Mobile and Stationary Hospitals in Rural Bangladesh.

The aim of this study is to compare accessibility of vision-impaired (VI) patients to other eyecare centres before attending the mobile and stationary hospitals. Under a cross-sectional study design, VI patients were consecutively enrolled if they visited one of the three Impact Foundation Hospitals—one mobile and two stationary hospitals. The cost and service output of all hospitals were also reviewed; 27.7% of patients at the mobile and 36.8% at the two stationary hospitals had sought eyecare at other health facilities in the past. Mobile hospital patients lived closer to the hospital but spent more time in travelling, bore less direct cost, needed less extra support, and had a higher level of satisfaction on the service. They also identified more barriers to access eyecare in the past. The mobile hospital had a higher percentage of patients with accessibility problems and should continue to help the remote population in overcoming these problems.

Effect of helminthic infections together with mite allergen exposure on the risk of wheeze in preschool children.

Although some studies have indicated that helminthic infections and house dust mite exposure may have an alleviating effect on wheeze, an interaction effect of both risk factors has not been examined in Thailand. The objective of this study was to investigate whether exposure to helminthic infections together with house dust mite allergen was associated with wheeze in children aged 18-36 months, living in an area of southern Thailand where helminthic infections are endemic. This study was undertaken as a part of The Prospective Cohort Study of Thai Children which recruited 1,076 children born between December 2000 and November 2001. A home dust sample was collected once when the infants were 12-18 months old to measure house dust mite allergen (Der p1). Questionnaire data on wheeze and a stool specimen for soil-transmitted helminth analysis were collected at age 18-36 months. Prevalence of exposure to house dust mite allergen (Der p1) > 10 μg/g dust was 31.8%. Soil-transmitted helminths were present in 25.0%, predominately Ascaris lumbricoides. Hookworm infection was asso-ciated with a physician’s diagnosis of wheeze (OR 4.20, 95% CI 1.45-12.10) and hospitalized wheeze (OR 5.40, 95% CI 1.26-23.01). Hospitalized wheeze was significantly higher in subjects exposed to Der p1 2-10 μg/g dust. Helminthic infections were not associated with a significant interaction effect with mite allergen against a risk of wheeze. Our survey confirms that hookworm infection and mite allergen exposure are independent risk factors for childhood wheeze and there is no evidence of important interaction between the two.

Financial Barrier against Access to Diagnostic Procedures among Enteric Fever Suspects in Highly-endemic Areas of China.

There is currently no public financial system that fully covers enteric fever suspects in China. This study aimed at documenting the level of access to definitive diagnostic procedures, especially haemoculture, for these patients and examining the effect of health insurance on access to such care. A hospital-based cross-sectional study was conducted in six counties of Yunnan province, using a structured questionnaire and data extraction from medical records. In total, 714 subjects were recruited. Chi-square test and logistic regression were employed for analysis of data. The majority of the subjects were young adults (52%) and farmers (55%) from low-income families (49%). Only 407 (57%) could afford haemoculture routinely advised by their doctors. Of these, 123 (30%) had haemoculture positive for Salmonella Typhi. After adjustment for income, not getting haemoculture was marginally associated with percentage of reimbursement from the insurance (p value for trend=0.047). Illiteracy was also an independent risk factor for this outcome. The poor coverage of haemoculture for patients suspected of having enteric fever in this endemic area was due to financial barrier. The current health-insurance system inadequately relieved the problem. Further financial reform to help patients suspected with enteric fever is required.

Contextual and individual demographic determinants of alcohol consumption and smoking: a comparative study in southwestern China and southern Thailand.

The aim of this study was to investigate the association between contextual and individual demographic characteristics and alcohol consumption and smoking in southwestern China and southern Thailand. In 2000, a cross-sectional study was carried out in southern Thailand on 703 subjects > or = 45 years old, and in 2005 in southwestern China on 6,006 subjects. Each participant was interviewed by trained interviewers using a standard questionnaire. Information regarding demographic characteristics, alcohol drinking and smoking was obtained. Multilevel logistic regression was used to model variation in the prevalence of alcohol consumption and tobacco smoking. The findings in both countries indicate that age was negatively associated with the probability of consuming alcohol and males were more likely to consume alcohol and tobacco than females. Chinese communities with a lower level of education were more likely to smoke. Thai individuals with a higher educational level were less likely to smoke. Yi ethnicity was associated with a higher probability of drinking both at the contextual level and at the individual level in China. Non-Muslims were more likely to consume alcohol in Thailand. Future contextual and individual level interventions regarding alcohol drinking and smoking are needed in China, and further studies with larger sample sizes are needed in Thailand before conclusions can be drawn.

Geographical variation of mortality in Thailand.

OBJECTIVE: To examine geographical variation of mortality in Thailand. MATERIAL AND METHOD: Descriptive ecological study using the national vital registration data in 2000, age-specific mortality rate and cause-specific standardized mortality ratio (SMR) were presented at district geographic level. RESULTS: Overall mortality was highly concentrated in the middle part of the upper north, as well as mortality of the working age. Clustering of cause-specific SMR in a single region was found for liver cancer (in the upper northeast region) and chronic obstructive pulmonary disease (in the upper north region). Clustering in multiple regions was found for renal failure (in the upper north and the upper northeast regions). Dispersed pattern of mortality with no regional clustering was found for leukemia. The geographical pattern of cause-specific mortality might be explained by distribution of incidence and related risk factors. CONCLUSION: Geographical variation of mortality exists and should be used as a target for reducing mortality gap across geographical areas.

Perioperative desaturation and risk factors in general anesthesia.

OBJECTIVE: Despite advances in anesthetic technique, the incidence of perioperative desaturation in general anesthesia has remained high. Knowledge on factors associated with intraoperative desaturation is relatively scanty. The purpose of the present study was to investigate the distribution of time dependent intraoperative desaturation and factors predicting perioperative desaturation. MATERIAL AND METHOD: A prospective observational analytic study was conducted. One thousand and ninety three patients schedule for elective surgery under general anesthesia (GA) were enrolled. Exclusion criteria were patients with preoperative arterial oxygen saturation (SpO2) < or = 95%, pregnant women, obvious difficult airway and those requiring mechanical ventilation postoperatively. Desaturation was defined as oxygen saturation < or = 95% for > or = 10 seconds. RESULTS: Among 1093 eligible cases, 30 cases (2.74%) developed intraoperative desaturation. The probability of desaturation during induction, maintenance, and emergence were 0.55% (6/1093), 2.01% (22/1093), and 0.18% (2/1093), respectively. Occurrences of desaturation at the recovery room (RR) were noted in 224 patients (20.49%). Younger, obese patients, snorers, and lower respiratory tract infection were significant high-risk groups of intraoperative desaturation. Elderly, obese patients, snorers, positive history of pulmonary disease, modified Aldrete's score < or = 8, and duration of GA > or = 180 minutes predicted desaturation at RR. CONCLUSION: Obesity and snorers were the high-risk groups of perioperative desaturation. Elderly patients are at lower risk of desaturation than children intraoperatively, but at a higher risk in the postoperative period Higher FiO2 should be given to high-risk patients during the intraoperative period. Desaturation can still occur at RR, even in patients who received oxygen. Pulse oximeter monitoring should be continued throughout RR care.

Hospitalized infant morbidity in the Prospective Cohort Study of Thai Children Project.

BACKGROUND: Infant morbidity causes a substantial resource burden, however, its magnitude and pattern in developing countries is still unknown. MATERIAL AND METHOD: The authors prospectively followed a cohort of 2,739 children over a one-year period in three rural areas of Thailand to detect the hospitalized infant morbidity. RESULTS: The incidence of morbidity was 454.9/1,000 live births. The top five morbidities were perinatal conditions, respiratory diseases, pneumonia, infectious diarrhea, and disorders related to short gestation/ low birth weight, and had an incidence of 88.7, 35.4, 34.3, 30.3, and 23.0 diagnoses/1,000 live births, respectively. They accounted for 1,973 days (76.6%) of hospital stay Of all morbidities, 34.8% occurred in the early neonatal period and 3.1% occurred in the late neonatal period. CONCLUSION: The present study confirmed that perinatal conditions in the early neonatal period and pneumonia and diarrhea in the post neonatal period are still an important health problem. Further attempts for prevention and control will be needed.

Gender and ethnic differences in cardiovascular risks in Songkhla province, Thailand: the interASIA-south.

The subset of data on southern Thai InterAsia study conducted in 2000 was revisited in order to document gender and ethnic breakdown of prevalence of risk factors for cardiovascular diseases (CVD). Three hundred and seventy-five men and 630 women with overall mean +/- SD age of 53.2 +/- 11.7 years were recruited. Combined gender prevalences were: 21.1% for smoking, 15.5% for drinking, 21.8% for hypertension (systemic blood pressure > or = 140/90 mmHg), 49.8% for impaired fasting plasma glucose (FPG 110-125 mg/dl), 9.9% for diabetes mellitus (FPG > or = 126 mg/dl), 10% for body mass index > or = 30 kg/m2, 43.5% for large waist circumference (WC > or = 90 cm in men and > or = 80 in women), 62.8% for total serum cholesterol (TC), > 200 mg/dl, 38.5% for TC divided by high density lipoprotein cholesterol (HDL-C) > or = 5 and 61.6% for low-density-lipoprotein cholesterol (LDL-C), > or = 130 mg/dl. After using logistic regression, adjusting the effects of age and community of residence, women were less likely than men to be smokers, drinkers, or showed impaired FPG but significantly more likely to have large WC, TC > or = 200 mg/dl and LDL-C > or = 130 mg/dl. Muslims showed significantly lower risk for drinking and large WC but higher risk for low HDL-C. The differences require further research. In conclusion, gender and age have stronger association with various risk factors than ethnicity in this selected population.

Associations between floor activities and knee osteoarthritis in Thai Buddhist monks: the Songkhla study.

OBJECTIVE: Whether floor activity, a common daily activity among Buddhist monks, is a risk factor for knee osteoarthritis remains controversial. The objective of the present study was to search for any association between floor activities and knee osteoarthritis. MATERIAL AND METHOD: This population-based survey involved 261 monks, 40 years of age or older from Songkhla province in the southern part of Thailand Histories were taken on lifetime floor activities in four common positions, squatting, lotus, side-knee bending, and kneeling. Radiographic investigations included antero-posterior and skyline views of both knees. Diagnosis of osteoarthritis in each compartment was based on Kellgren & Lawrence grade 2 or more. Logistic regression analysis adjusted for age, body mass index and smoking status was used to identify the associations between lifetime floor activity and knee osteoarthritis. RESULTS: The mean age (SD) of monks in the present study was 60.4 (12.7) with mean age at ordination 44.4 (17.6) years. The lotus and side-knee bending positions were the two most common practices. Using the lowest tertile of exposure to lotus position as a reference, the third tertile had an odds ratio of 1.0 (95% CI; 0.5-2.2) associated with radiographic knee osteoarthritis. The corresponding odds ratio for side-knee bending was 0.8 (95% CI; 0.3-1.7), for squatting 2.1 (95% CI; 0.9-4.5), and for kneeling 0.7 (95% CI; 0.3-1.5). There was no significant association between the average daily lifetime floor activity in any positions and symptomatic radiographic knee osteoarthritis. CONCLUSION: Floor activities involving squatting, lotus, side-knee bending and kneeling do not increase the risk of knee osteoarthritis in Thai Buddhist monks.

Comparison of validity, and responsiveness between general and disease-specific quality of life instruments (Thai version) in knee osteoarthritis.

Short-form 36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) are common instruments for measuring quality of life (QoL) in patients with knee osteoarthritis. The goal of the present study was to compare the performance of both instruments in evaluating QoL in patients with knee osteoarthritis as diagnosed by the American College of Rheumatology (ACR) criteria. Treatment included nonsteroidal anti-inflammatory drugs and patient education for 6 weeks. Face-to-face interview by an orthopaedist was done at baseline and after treatment, including collection of demographic data and use of both SF-36 and WOMAC questionnaires. Evaluation of instrument performance included reliability, validity, and responsiveness measures. Reliability was tested by analysis of internal consistency using Cronbach's alpha at baseline and after treatment. Construct validity was computed by determining the correlation between each domain of SF-36 and WOMAC (Pearson's test). Responsiveness was compared between baseline and after treatment of both SF-36 and WOMAC in each domain using the paired t test. Fifty-two patients (8 men, 48 women) with a mean age of 58.4 years were included in the present study. About 75% of subjects had less than secondary education levels and most were from agricultural communities. Sixty-four percent had mild grade knee osteoarthritis. The internal consistency of WOMAC revealed good levels of reliability, both at baseline and after treatment, in all dimensions. The reliability of SF-36 was relatively low, especially in the role physical and bodily pain dimensions (Cronbach's alpha < 0.700). Construct validity between each dimension in SF-36 and WOMAC demonstrated coefficients ranging from -0.05 to -0.409. Both WOMAC and SF-36 showed good responsiveness when comparing scores before and after treatment in all domains. In conclusion, both the Thai version WOMAC and SF-36 were valid, reliable, and sensitive to change in evaluating QoL in Thai patients with knee osteoarthritis.

Antenatal care providers' practices and opinions on the services of antenatal syphilis screening in Ulaanbaatar, Mongolia.

The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings were all 16 antenatal care clinics, and a random selection of 30 family units from six districts in Ulaanbaatar, Mongolia. Interviews were conducted with 150 antenatal care providers and 27 antenatal care heads/leaders. Antenatal syphilis screening in Ulaanbaatar was complex. Most pregnant women had antenatal care at family units or antenatal clinics, but syphilis blood testing could be performed only in some district general hospitals. Syphilis positive-screening cases were referred to the venereologists for confirmation of results, appropriate treatment, contact tracing, and follow-up. The providers agreed with the need for syphilis screening in pregnant women but identified as constraints the limited time for performing the screening due to late antenatal visit, women's lack of knowledge, poverty, and geographic barriers. The practice of providers varied, and the opinion on a one-stop service was positive. The main conclusions concerning the failure of universal antenatal syphilis screening were limited accessibility and feasibility of the service, and the ignorance of both women and providers on the importance of screening. It was agreed that decentralization of antenatal syphilis screening would improve the system.

Clinical severity and financial burden among road traffic injury patients in Kunming, China.

This study aimed to describe the severity of injury (RTI), length of stay, costs, financial burden, and sources of payment for RTI patients in the Kunming area, Yunnan Province, China. Information was collected from interviewing 420 patients admitted with RTI during January to May 2005 and from medical records reviewed of all the patients admitted from January to 30 May 2005. The costs and financial burden of road casualties on the medical sector resources were found to be large (median = RMB 94,496) compared to the average per capita monthly income of the Yunnan population (RMB 798). Most patients had injuries of moderate severity. Pedestrians and passengers had the highest Injury Severity Score (ISS). The mean payments out-of-pocket, from the government and by compensation were RMB 5320, 10,190 and 11,190, respectively. In addition to prevention of RTI, a suitable insurance system is needed in the country.

The prevalence and determinants of iron deficiency anemia in rural Thai-Muslim pregnant women in Pattani Province.

This study was conducted in order to describe the type of anemia and risk factors for iron deficiency anemia in Pattani Province, Thailand. A cross-sectional survey was conducted from March to October 1997 in five randomly selected districts, choosing villages in the catchment area of a random sample of 30 out of 57 health centers (HC). All resident eligible pregnant women (PW) at 32-40 weeks of gestation without any overt diseases were selected. Food intake and antenatal health history were assessed by a food frequency questionnaire, health questionnaire and a review of HC records. Of the 180 enrolled PW, the prevalence of iron deficiency (ID), iron deficiency anemia (IDA) and other anemia were 34.4, 37.8 and 7.8%, respectively. PW in the last group were excluded from the analysis of predictors of iron status. Stool samples were obtained from 130 PW. The prevalences of hookworm, Ascaris and Trichuris were 47, 48 and 25 %, respectively. The number of ante-natal care (ANC) visits ranged from 0-8 with a median of 3 visits. Of those PW who visited, 97% reported receiving iron tablets. The compliance rate with iron tablets was low especially in the third trimester (9-12 %). Ordinal logistic regression showed that the risks for ID and IDA were reduced with statistical significance at a gestational age greater than 34 weeks, with more than three ANC visits, and increased consumption of meat and calories, but increased with hookworm infection. Compliance with iron tablet supplementation did not significantly reduce the risk for ID and IDA. In this study, PW had high percentages of ID and IDA. The risk factors identified in this report require intervention to eliminate them.

Neonatal mortality in rural Bangladesh: an exploratory study.

Bangladesh has a neonatal death rate that is substantially high and demands urgent attention. To assess the causes of neonatal mortality, 1,019 pregnant women were followed up in eight randomly-selected rural areas of the country. Trained female interviewers visited the households of the subjects at four-week intervals to record neonatal deaths (within 28 days after birth). For each death, they administered a structured verbal autopsy questionnaire to the mother and/or a close family member. Based on these field data, three neonatologists arrived at a consensus to assign two causes of death--an originating cause and a direct cause. The neonatal mortality rate was 53.5 per 1,000 livebirths. The originating causes of death were pre-maturity/low birth-weight (30%), difficult labour (16%), unhygienic birth practices (16%), others (4%), and unknown (34%). The direct causes were sepsis (32%), asphyxia (26%), tetanus (15%), respiratory distress (6%), others (6%), and unknown (14%). According to the prevailing causes of neonatal deaths, implementation of intervention programmes, often in the community, that do not depend on highly-technical training or sophisticated equipment should be implemented.

Comparison of the quality of life of general hospital outpatients in southwest China with southern Thailand.

This is a collaborative study comparing the quality of life (QoL) and its predictors between outpatients of university teaching hospitals in southwest China and southern Thailand in terms of different domains of QoL as well as whether socio-economic variables affect the QoL of the two groups of patients to the same extent. Two hundred sixty-one and two hundred forty-eight randomly chosen outpatients were recruited at Chinese and Thai hospitals, respectively, and were interviewed using the SF-36 scale. The QoL of the Chinese patients had a higher adjusted score for 'physical functioning', but the scores for 'role limitations attributed to physical problems and emotional problems' were higher in the Thai patients. Multiple regression analysis showed that sex, marital status, education, family income and residency were predictors of the total QoL score. Age and area had significant interactions with 'country' in the general health domain.

Pregnancy loss in the Philippines.

In this cross-sectional study, 8,481 women aged 15-49 who had at least one pregnancy outcome were considered. This study aimed to examine the characteristics of Filipino women having had a pregnancy loss, and to test the association between domestic violence and pregnancy loss. To control for the confounding effect of the number of pregnancies, the sample was divided into seven groups classified by the number of pregnancies. The risk factors considered were demographic characters (age and partner's age, marital status, and place of residence), socioeconomic status (education and partner's education, having a paid helper at home, having a say in how income was spent), domestic violence (physical abuse and forced sex), sexual behavior of partner, whether the pregnancy was wanted, and disease history (tuberculosis, diabetes, hypertension, malaria, hepatitis, kidney disease, heart disease, anemia, goiter and other medical problems). The major risk factors were found to be physical abuse, region, faithfulness of partners, hypertension, hepatitis, kidney disease, anemia, and the other medical problems, respectively. The risk of pregnancy loss for the women suffering domestic violence was 1.59 (95% CI 1.28-1.97) times higher than for the women who did not. Women aged 15-19 years had a much higher risk of pregnancy loss than the other age groups (OR = 1.49, 95% CI 1.22-1.82). There were similar risk for women aged 20-24 years (OR = 1.08, 95% CI 0.94-1.25) and 35-39 years (OR = 1.05, 95% CI 0.92-1.19). No association emerged with marital status, socioeconomic status, forced sex, the number of partners, unwanted pregnancy, tuberculosis, diabetes, malaria, heart disease, and goiter. Although women's age, partner's age, residence, women's education, partner's education, and paid helper at home were significantly associated with pregnancy loss, they were likely to be confounders rather than risk factors.

Fatal nosocomial infection in medical wards of a University Hospital.

Nosocomial infection is one of the most common morbidity among hospitalized patients. While study dealing with epidemiologic pattern of those in living patients are numerous, studies focusing on patients who died of them are few. In this prevalence study, we found that patients having fatal nosocomial infections presented some distinguishable features. From May 1982 to December 1983, 109 out of 300 cases had fatal nosocomial infections (36.3%). There was a total of 168 episodes of infection in these patients (1.5 episodes per patient). The ages ranged from 13-91 years and both sexes were equally affected. Septicemia was the most common infection related directly to death (a causal relationship). Pneumonia was commonly contributing to death while urinary tract infection was the most common infection not related to death. Most patients had either rapidly fatal or ultimately fatal underlying diseases. The infections disease episodes in both types of underlying diseases were not significantly different. There was a bimodal age group distribution of those who died of infections (30 and 60 years). The peak survival was rather short (mode of 20.0 days) and the fatal infection occurred early in the hospitalized course (mode of 5.0 days). These data suggested that the prevalence of fatal nosocomial infection was high severe infection occurred early and types of infection may be a predictor of fatal outcome,. Any intervention focusing on prevention of severe infection, such as septicemia and pneumonia, should be encouraging.