Impact of maternal chronic illness on pregnancy outcome

Egypt is still having high maternal morbidity and mortality. Chronic diseases associated with pregnancy increases the risk of obstetric and neonatal complications ranging from manageable problems up to maternal and fetal mortality. These adverse outcomes are at least in part related to preconception care, monitoring during pregnancy and the proper place and time for termination of pregnancy.1- Exploring pregnancy outcome with common chronic illnesses. 2- Determining the possible underlying factors for unfavorable outcome associated with some chronic illnesses. 3- Fate of the studied patients. A stratified random sample of pregnant with associated chronic illnesses, attended to the emergency outpatient clinic of Kasr El Aini Obstetric and Gynecology Hospital, during the period of 1/10/2006-31/3/2007, were the subjects of this work. Resident physician in charge were asked to complete a pre-tested questionnaire form covering the information that could be collected in this adverse situation. The total sample was 188 patients 17 [9.0%] diabetes type I, 21 [11.2%] diabetes type II, 55 [29.3%] hypertensive, 36 [19.2%] chronic renal diseases, 12 [6.4%] liver cirrhosis and 47 [25.0%] chronic heart diseases. De-compansated conditions were about 78%, 21% attended in labor, about 50% with vaginal bleeding [abortion], 5 maternal deaths were reported. Out of those known terminating pregnancies, known fetal losses were 18 [16 miscarriage and 2 stillbirths, 8 LBW and one case with congenital anomalies]. If pregnancy is associated with chronic maternal diseases, adverse maternal and fetal outcome have to be expected. Hence the importance of foundation of a strategic plan, for their health education about their different chronic illnesses, early detection, monitoring and preparing suitable places for delivery. And this best to be applied on the bases of Primary Health Care or Family medicine clinics

Assessment of laboratory services in PHC units and first referral level hospitals in 5 governorates, Egypt 2002

Parallel to the development in the promotive, preventive; curative services in primary health care are expected to achieve more specially with the concomitant implementation of the referral system and family health record. Aim of this study is to assess the laboratory services in PHC and district hospitals and to evaluate the referral link as regards laboratory services between the two levels. This was across sectional descriptive study during 2002. In this study, all laboratories either in PHC units or hospitals in the five districts assigned for the Health System Upgrading Project II. A pre-designed pre-tested questionnaire form including data about the laboratory workers, their qualifications, and training experience. In addition, data about laboratory basic sanitary requirements, equipments, supplies and its logistics was collected. Referral system between the two levels will be investigated among a sub-sample of PHC laboratory in each district to explore the aspects of strengths and weakness if it is actually exists. Manpower was mainly laboratory technicians who were evenly distributed in different districts. The 2[nd] majority was assistant laboratory technician and they were mainly in Dyrute and Somosta [upper Egypt] 51/62 [82.3%]. Unqualified laboratory worker comes third. Doctors were only 8, and there was one District hospital [somosta] laboratory without a clinical pathologist. Although the mean duration of work as a laboratory Personnel was 13.3 +/- 9.6 years for PHC workers and 11.9 +/- 9.5 years for hospital laboratory personnel, the percentage of those not attending any training course was 54.2% [116/214]. A declining percentage for attending one course, two courses and three courses among PHC personnel and still lower of hospital personnel. Basic sanitary needs: were almost satisfactory except for few PHC units in Dyrute and kantara Gharb. Laboratory equipment and laboratory materials: PHC laboratory and hospital laboratory are generally satisfactory. Some vital equipment are deficient in some hospitals. The need for maintenance besides is vital training of available personnel to use such equipment. Materials for its proper utilization are essential. Needs for redistribution of some materials between hospital laboratories is recommended. Laboratory registration forms: Registration book is the only format we can consider satisfactory. Other format is either not available or available and neglected in some PHC and Hospital lab. The need for maintenance is vital, training of available personnel to use such equipment. Materials for its utilization are essential. Need for redistribution of some materials between hospital laboratories is recommended. Foundation for referral link is vital

Implications of primary health care integration among a group of upper Egyptian women: a community based study

Integration of the fragmented vertical program is crucial for the efficiency and effectiveness of the primary health care [PHC] services. Therefore, identification of the strengths and challenges confronting the integration process through family medicine [FM] approach in some pilot projects will give insight to the potential to capitalize on the gains achieved. The study is an operations research, post intervention design. It used a test health facility [PHC unit implementing FM approach in rural Upper Egypt], and a comparative health facility in a demographically matched village [PHC unit operating according to the traditional PHC vertical programs]. Data sources were household survey, service statistics, and in depth interviews with the principal official stakeholders. The findings show that, the volume of services delivered in the test group showed initial increase. However, with no pronounced community satisfaction As well, the profile of utilization pattern did not show improvement specially for the women. The study recommended the gradual informed introduction of the concept of integration for all the concerned stakeholders including the served community.