RESUMEN
Based on the primary health care [PHC] principals and approaches, the District Team Problem Solving [DTPS] approach has been developed, which is an effective tool for improving performance of health services at the district level
Aim of the work: The aim of this study is to assess the DTPS approach in MCH services in El-Sharkia Governorate through conduction of Rapid Health Appraisal [RHA] in selected rural health units
Subjects and Methods: A comparative cross-sectional study was carried out at rural districts from 1[st] May to end of October 2004. Two units applying DTPS versus other two units at the same district not applying this approach. Data were collected through three semi-structured questionnaires, two check lists for units' structure and performance of the providers and reviewing the relevant medical records
Results: The DTPS units have suitable site, sanitary surrounding environment, well equipped laboratories and available relevant equipment. The units were the first choice for majority of the consumers and visited it frequently [>5 times]. Child immunization was the most service used while antenatal care was the least one used in both groups of units. The majority of consumers of DTPS units stated that they were accessible for them, doctors were available and were satisfied about waiting and the examination time compared with those in non DTPS units. The main reason of service under-utilization in the non DTPS units was the households' non satisfaction about the units' structure, doctor's unavailability and its long distance from their residence. As regard performance of health care providers [physicians and nurses] there was a significant difference among them in both groups as effective communication with patients was observed among higher percentage of those working in DTPS units. Majority of health care providers in DTPS units were satisfied about the units' site and structure, community participation, attendance rate and the level of service compared with other group of units. Lastly, the units applying this approach has accurate, clear, complete record data with suitable record keeping compared to other group of units
Conclusion and Recommendations: Majority of health care providers and consumers of DTPS units ascertained that it is an effective approach in improving some administrative skills and better utilization of health services in these units. So, the study recommended its wide application in Egypt for continuous improvement of the administrative skills of health care providers. Also, continuous training courses for them to improve their technical skill and updating their knowledge
RESUMEN
As menopause is a natural phenomenon among all females that associated with risk of developing several long term diseases. Determinant factors associated with onset of that menopause need to be more explorated
Aim of work: studying different factors associated with age at menopause, focusing on factors associated with early onset of natural menopause
Subjects and Methods: a cross - Gectional study was conducted from May to September 2004, at Zagazig district. Nine hundreds and twelve fenlales [40 years and more] were interviewed after considering the needed sample size. The main sociodemographic, life style and biologic variables were inquired from them through a predesigned questionnaire. Score of physical activity as well as some anthropometric measurements were applied to them
Results: there were a significant association regarding history of chronic diseases[hypertension, diabetes..etc], insufficient income, marital status as [single, widow or divorced], and using an intrauterine contraceptive device [IUD] among menopaused females, [Odds Ratio: 5.41, 2.07, 1.9 and 1.74 respectively]. High kids number [4,+] late age at menarche [>15 years] as well as irregular and variable menses duration were significantly higher among menopaused females. Physical activity was not only significantly more affected among those group, but also much affected among those who developed early menopause [<45 years] [odds ratio: 4.83 and 3.56 respectively]. Early age at natural menopause was also significantly associated with non working status, insufficient income as well as [single, widow or divorced] and tilose with long and variable menses duration
Conclusion: among the significant factors, logistic regression analysis revealed that; menses duration [long/variable], non working status and marital status [single, widow or divorced] were the significant predictors for early onset of natural menopause. So, attention should be paid to those groups by regular health education and medical follow up for early prevention of the associated risks of multiple diseases