Sensitivity and specificity of malaria rapid diagnostic test (mRDT CareStatTM) compared with microscopy amongst under five children attending a primary care clinic in southern Nigeria

Background: Malaria diagnosis using microscopy is currently the gold standard. However, malaria rapid diagnostic tests (mRDTs) were developed to simplify the diagnosis in regions without access to functional microscopy. Aim: The objective of this study was to compare the diagnostic accuracy of mRDT CareStatTM with microscopy. Setting: This study was conducted in the paediatric primary care clinic of the Federal Medical Centre, Asaba, Nigeria. Methods: A cross-sectional study for diagnostic accuracy was conducted from May 2016 to October 2016. Ninety-eight participants were involved to obtain a precision of 5%, sensitivity of mRDT CareStatTM of 95% from published work and 95% level of confidence after adjusting for 20% non-response rate or missing data. Consecutive participants were tested using both microscopy and mRDT. The results were analysed using EPI Info Version 7. Results: A total of 98 children aged 3­59 months were enrolled. Malaria prevalence was found to be 53% (95% confidence interval [CI] = 46% ­ 60%), whilst sensitivity and specificity were 29% (95% CI = 20% ­ 38%) and 89% (95% CI = 83% ­ 95%), respectively. The positive and negative predictive values were 75% (95% CI = 66.4% ­ 83.6%) and 53% (95% CI = 46% ­ 60%), respectively. Conclusion: Agreement between malaria parasitaemia using microscopy and mRDT positivity increased with increase in the parasite density. The mRDT might be negative when malaria parasite density using microscopy is low

Predictors of site choice and eventual learning experiences in a decentralised training programme designed to prepare medical students for careers in underserved areas in south Africa

Background. There is a dire need for medical schools in South Africa to train medical doctors who have the capacity and willingness to work in primary healthcare facilities; particularly in rural areas. Objectives. To assess the effect of students' gender; race; place of birth and place of high school completion on their choice of training site location and to assess the extent to which the training programme enhanced students' learning experiences relevant to primary care across training sites. Methods. A survey design involving six cohorts of 4th-year undergraduate medical students (N=187) who were part of the 2013 Family Medicine rotation at the Nelson R Mandela School of Medicine. Self-administered questionnaires were completed by students at the end of each rotation. Data analyses involved descriptive computations and inferential statistical tests; including non-parametric tests for group comparison and generalised polynomial logistic regression. Results. Students believed that their knowledge and skills relevant to primary care increased after the rotation (p0.0001). There were statistically significant differences between rural and urban sites on certain measures of perceived programme effectiveness. Male students were less likely to choose urban sites. Black students were less likely to choose rural sites compared with their white and Indian counterparts; as were students who attended rural high schools (odds ratio (OR) 9.3; p0.001). Students from a rural upbringing were also less likely to choose rural sites (OR 14; p0.001). Conclusion. Based on the findings; an objective approach for student allocation that considers students' background and individual-level characteristics is recommended to maximise learning experiences

Medical Student Participation in Community-based Experiential Learning: Reflections From First Exposure to Making the Diagnosis

Background: Fifth-year medical students from the University of Pretoria participated in a four-week rotation in the primary care clinics of a large metropolitan centre. An academic service-learning (ASL) approach was introduced into this rotation to improve the integration of theoretical learning and clinical practice through relevant community service and structured reflection.Methods: Students wrote semi-structured reflective journals as a means to gaining greater insight into their learning experiences. These reflections were analysed qualitatively with a view to improving the community-based curriculum.Results: Four major themes were identified: expectations and the reality of primary care; service and learning; becoming a doctor; and making a difference.Conclusion: While students gained a deeper insight into their development as clinicians; using an ASL approach also assisted the faculty in making an informed educational diagnosis of the curriculum

Training on the Practical Approach to Lung Health: effect on drug prescribing in PHC settings in Jordan

This study assessed whether training physicians on the Practical Approach to Lung Health [PAL] reduces drug prescribing and the cost of drugs prescribed to respiratory patients in the primary health care setting. Data were compared before and after training general practitioners on standard guidelines for case management of respiratory conditions in primary care. A total of 56 general practitioners practising in 25 health centres in 3 out of 12 governorates of Jordan participated in both the baseline survey [n = 6260 respiratory patients] and the impact survey [n = 2709 patients]. Training in PAL decreased by 12.2% the number of drugs prescribed per patient, increased the prescription of inhaled medications and reduced the mean cost of a drug prescription per patient by 8.7%

barriers of breast cancer screening programs among PHHC female physicians

While breast cancer is a serious health problem to countries as well, breast cancer screening remains underutilized because of many barriers such as costs, pain due to mammogram procedures, lack of knowledge about the benefits of early screening, and many other barriers such as cultural or social factors. But fighting breast cancer means educating women on the importance of early breast screening and detection for prevention as well as for management. In order to educate the general population on the benefits of breast cancer, the present study was done to identify and describe barriers to early detection of breast cancer. This is a survey of 75 female PHC physicians who responded out of the total 79 available female physicians in 43 Primary Health Centers in Al Khobar, Al Dammam, and Al Qatif, Saudi Arabia in 2004 regarding the barriers in implementing of breast cancer screening programs using a specially designed questionnaire which divided into two parts [demographic data, and items regarding barriers in implementing breast cancer screening programs]. Most of the female physicians were Saudi [65%] with mean age of 35.93 +/- 7.23 in years from PHHCs in Al Khobar, Al Dammam, and Al Qatif. The average mean duration of work as physician is 8.82 years and the average duration of work a PHC physician is 8.2 years. 95% of physicians in the study did not undergo post graduate training as compared to literature. The 2 physicians [5%] in the study did not have graduate degrees in family and community medicine but had master's degree in pediatrics [3], obstetrics [1], and gynecology [1]. The physicians reported the different barriers which have prevented them from practicing screening programs in PHHCs with the main barrier given as: there was no national screening program [56 physicians], time pressure [55 physicians], physician's lack of training [48 physicians], lack of good communication between physician and patients [46 physicians], there were not enough facilities in the PHHCs [42 physicians], lack of women cooperation and trust [33 physicians], walk-in clinic [4 physicians], and social and cultural reasons [4 physicians]. Costs and unavailability of mammography are the main barriers in other countries including the United States of America. Such is not the case in Saudi Arabia since mammography is usually given free to Saudi citizens or is part of the patient's insurance coverage. It was found out that physicians who thought that BC screening is important tended to advice patients to undergo BC screening. Physicians with low scores in BC epidemiology in Saudi Arabia claimed Saudi women are not at risk of BC [p = 0.04]. The main barrier of the BC screening program which may be instituted by PHCs female physicians was unavailability of a national screening program. Other barriers include time pressure, lack of training on the part of the physician, lack of good communication, there were not enough facilities in the PHHCs, lack of women cooperation and trust, walk-in clinic, and social and cultural reasons. Development and institutionalization of breast cancer screening program, massive educational program on breast cancer using multi-media tools and strategies, training and intervention program for PHC physicians on breast cancer including screening and early detection, and inclusion of breast cancer education on the medical curriculum are some of the recommendations arising from the study's results

effects of breast cancer early detection training program on the knowledge, attitudes, and practice of female PHHC physicians [Eastern Province; 2004]

It has been shown by many studies that early detection and management of breast cancer had decreased mortality and morbidity from the disease. Several studies showed that physicians' ordering of screening depended on: levels of confidence and comfort, and knowledge of breast screening guidelines, 11 their colleague's mammography practices, the adequacy of insurance coverage, and how often they had spent an unreasonable time explaining mammography results, 12 and beliefs of physicians.1 The present study studied the effects of breast cancer early detection training program on the knowledge, attitudes, and practice of female PHHC physicians. This is a non-r and omized experimental design with 45 PHCCs' female physicians in Al Khobar, and Al Qatif cities [experimental group] during the period: Oct 2003- Feb 2004 participating. A workshop on knowledge of BC concepts and skills was developed and implemented on the participants. A 3-part structured questionnaire [demographic data, general knowledge, and early detection] based on fundamental knowledge of breast cancer and early detection was used as pre-post test instrument. The knowledge measurement is composed of 65 close-ended items with two choices [agree/disagree]. A 30-item likert type of 5 choices questions were used to assess the attitudes of physicians. The Mamma Care program models were used to assess the ability of the physicians in detecting lumps and evaluating the nature of breast tissues. Another part of the assessment tool was the practice part totaling to 16 points, which assessed the lumps using two breast models with 5 lumps. The cut-off points of Knowledge and Practice are: Poor < 60%, Good 6 1-80%, Excellent > 80%. The cut-off points of attitudes were determined after taking the mean of all the respondents. 65% of the respondents were Saudis, 95% hold bachelor's degree and 5% held master's degree. The mean age was 35.91 years. The mean duration of PHHC practice was 6.065 years, and mean duration of practice is 8.35 years. The findings of the study show that the program improved the PHC physicians' KAP significantly. Before intervention was given, the physicians had good knowledge about breast cancer and early detection [67%], but scored low regarding practice of BC [36%], and just 37% had a positive attitude. The pre and post-test mean scores of female physicians on the study group show a marked significant increase on the indicators of KAP after intervention; for knowledge from 67% to 96% [p < 0.001], attitude from 68% to 78% [p < 0.001], and for examination skills from 33% to 77% [p < 0.001]. Before intervention was given, the physicians had good knowledge about breast cancer and early detection but scored low regarding practice of BC early detection and had a negative attitude of it too, and after the educational program, there were significant positive changes in physicians KAP

Algunos indicadores del estado de salud de escolares del nivel primario de educación / Some health status indicators of first grade school-children

Se exponen los resultados del estudio del estado de salud de niños y adolescentes de 5 a 12 años de edad, alumnos de primero a sexto grado de escuelas semiinternados del municipio Marianao. Los indicadores tomados en consideración fueron: índice de salud, grupo de salud, nivel de salud y duración promedio de la enfermedad en días. Se expone además la estructura de la mortalidad de las edades abarcadas en la investigación