Health work force in Egypt

Egypt has a long history in health care and medical practice that stems from the Pharonic and Arab heritage. Throughout the last decades, the country has achieved impressive improvements both in health indicators and health care provision. Health care system has established an extensive network of primary health care units covering the entire population. However, Ministry of health and population, MOHP, is facing the challenges of maintaining these improvements and executing more improvements for providing high quality health care [1]. One milestone for health planning is human resources. It is recommended to have adequate quantity and quality of different health team members. Balanced distribution of different specialties allover the country to attain equity in health care. This study will focus on physician's number in the past years till now to suggest our needs of doctors in the future. From the previous information we deduce that there was high discrepancy in data. The first step to plan for work force in Egypt is to get accurate data base. Ministry of health and population should prepare survey study to calculate the number of physicians [and other health team workers] in service. The number of physicians having postgraduate certificates in the different specialties. Distribution of physicians in the different governments by specialty. The second step after this situational analysis is to analyze these data to know the number needed of physicians, the needed specialties, the ideal distribution of physicians in the different governments to assure equity of service. The future needs-of physicians can be calculated in relation to the expected number of population increase. This number of physicians needed in the future will be the guide for the number of students to be admitted to faculties of Medicine and a guide for postgraduate planning. The quantity of physicians is not the only indicator for the health service effectiveness, the quality of physicians is also important. In some countries as Israel, Sweden [in table 4] the number of physicians to 10000 of population is very high in comparison to Egypt [nearly 7 folds] but the question is [can we solve our health problems by only increasing the number of doctors?] we think assuring quality is more important than increasing quantity

Rapid health appraisal of rural health units adopting district team problem solving [DTPS] in Sharkia governorate - Egypt

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

Evaluation of the health service performance in outpatient clinics in Zagazig University

Many illnessess now can be treated on an ambulatory base [outpatient care] due to the shortage of hospital beds and escalation in operating expenses for inpatient care. The objective of this study is to evaluate the health service performance in Outpatient Clinics in Zagazig, University Hospitals for the sake of promotion of health services in these clinics. This work was done at the Pediatric and Gynecologic Outpatient Clinics, Zagazig University Hospitals. The health care - providers [physician number 37] and a random sample of 800 consumers of both studied clinics, were included in the present study The performance of the health service was evaluated by assessment of structure, care process, and outcome of care of the studied clinics.The work conditions of the studied outpatient clinics were satisfactory in general, but that for site, area and artificial ventilation of the Gynecologic clinic were inadequate. Lavatones and booklets were not adequate in both clinics while posters were not available in Gynecologic clinic The required medical equipments were available in Pediatric [35%] and Gynecologic clinics [73.9%], while non medical ones represented 62.5% and 68.7% of the required items respectively. Drugs availability was not satisfactory [at both studied clinics] according to both providors and consumers oponion. One record was present at each clinic in which recorded data were inaccurate and incomplete. Functional analysis of physicians showed that their performance was generally satisfactory except for completing ticket data and supervising subordinates. About case management, there was deficiency in communication skills [e.g. welcoming of the patient] versus manual skills [e, g.local examination] Consumer study revealed that rural residence and lower levels of education were significantly associated with higher degree of satisfaction. But consumers of both studied clinics were generally satisfied with service offered except for waiting time at Pediatric clinic. Institution of a quality assurance program to monitor the health service performance at the outpatient clinics on a regular basis is highly recommended

leading causes of under utilization of M.C.H services in Alexandria

The aim of the study is identifying reasons for underutilization of MCH services and necessary equipments and supplies needed to permit doctors to deal with obstetrical management. The main instrument of data collection was interviewing household mothers and health personnel in the area of work. The results revealed that the majority of household mothers [55%] used the available MCH services. The main causes of underutilization of health services were inconvenient accessibility, lack of specialists and lack of free drugs. Most of deliveries [67%] were carried out by private physician due to lack of necessary supplies and equipments needed for obstetrical managements

Identification of some socio-demographic factors contributing to child work in Zagazig Area

This study was carried out to detemrine some of the socio-demographic factors contributing to the phenomenon of child labour in Zagazig area. One hundred and twenty nine working boys aged from 6 to 15 years were included in this study. One hundred and thirteen non-working boys of the same age range from the neighbourhood were simultaneously studied as controls. Personal interviews were carried out using a structured questionnaire. Weight in kilograms and height in centimeters were assessed and blood haemoglobin concentration in gm/dl was esrimated for all children. The findings of this study showed that child labour is associated with large families, inadequate educational opportunities, fathers' illiteracy and irregular income. Poverty was the foremost cause of taking up employment. It was also found that most of the children had started work before the legal age. The overall effect of child work found were nutritional defeciency and work-related injuries. It was concluded that illegal child labour continued to be prevalent due to failure to enforce existing laws and standards. So, we recommend that strict efforts should be done to enforce the existing legislations to prohibit child work below the legal age

Study of physical fitness status among police security recruits

A cross sectional study was carried out to evaluate the level of physical fitness of new recruits of the central security forces and to study the effect of training and other various ecological factors on the level of their physical fitness. Seven hundred and twenty individuals were selected from the training camp of central security forces at Quesna district. Menoufia Governorate, to be the subjects of this study. The results showed that the training program had a significant positive effect on the physical fitness response and pulmonary function measurements of recruits. Smoking habits, residence. Hb concentration and bilharzial infection were important factors affecting response to training

Occupational mortality: an epidemiological study

This work was intented to study the occupational mortality as a measure of community health and to throw some light on health conditions of Egyptian population in different occupations. The standardized mortality ratio [SMR] was higher among male in clerical and agricultural work [181.59, 112.87]. A negative age gradient trends in SMR were observed in clerical, services and agricultural workers of male population and among administrators, sale and services female workers. Women in agricultural work showed an alarming high SMR both in whole Egypt or in Sharqia Governorate [309.11 and 223.02]. Regarding the previously noted results a suitable recommendations were proposed for achievement a high standard of occupations health

Effects of health education programme on knowledge about AIDS and HIV transmission in paramedical personnel working in Benha hospitals

Accurate information about acquired immunodeficiency Syndrome [AIDS] and human immunodeficiency virus [HIV] is important for prevention. This study is intended to asses AIDS knowledge in paramedical personnel working in Benha Hospitals and to measure the effect of health education programme done on knowledge about AIDS in general, modes of HIV transmission and their degree of misperception about transmission through causal contact. A well designed health education programme using personal communication and visual media techniques was conducted to 238 paramedical personnel working in Benha hospitals, during the year 1992. The results of this study pointed out that the means of the scores of general AIDS knowledge and transmission knowledge were greatly and significantly improved by the end of the programme [P<0.01]

Psychological and psychosomatic impact of work related stress among the staff members of Zagazig University Benha branch

This study was conducted among the staff members of Zagazig University, Benha Branch. The sample included 110 members from Faculties of Engineering, Sciences, Literature and Commerce. Another 38 subjects have been selected as a control group from the management sectors of the previous faculties. Subjects of both groups were subjected to assessment of work stress, mental health, behavioral reactions to stress and physical health. Conflicts, job pressure and job scope constituted the main problems among the staff members [38.18%, 34.55% and 37.27% respectively], while rapport with management was the main problem among the control [44.74%] subjects of practical faculties suffered more from work related stress. More females complained of being more dissatisfied with their jobs [37.5%] if compared to males [33.87%]. Also mental health traits, and the prevalence of some stress related behavioral reactions and symptoms appeared to be higher among the staff members than among the control group

epidemiological study of meningococcal carriers in an Egyptian village

This work was a cross-sectional study conducted in 1991 to assess the carrier rate of meningococci among students in El-Aslougy village [in Sharkia governorate]. The study included 200 students aged from 6 to 14 years old chosen from three schools in the village. Fifty students were chosen randomly from grade one, third, fifth and seventh grade. The prevalence rate of meningitis carriers was 5 percent [2.5 percent serotype A, 2 percent serotype C and 0.5 percent, serotype B]. All strains were sensitive to rifampicin, chloramphenicol and penicillin G. All were resistant to sulphonamides. Carriers were more prevalent among children from 6 to less than 8 year with no sex difference. There was a significant association between carrier rate and family size. The bigger is the family the higher is the carrier rate. A higher carrier rate was detected also in houses with crowdness index >3 [more than 3 individuals per room] and in the primary school where 4 pupils sit on the same desk with narrow distances between desks. The window area in the classroom was smaller than the standards and the number of water taps per students was 25 percent of the standards. Meningitis carriers were affected more by tonsillitis and bronchitis than non-carriers but there was insignificant difference as regards previous history of meningitis vaccination

Brucellosis in Egypt: a pilot explanatory study

Brucellosis represents a public health problem in Egypt. This disease is endemic in some governorates in which outbreaks were reported every year among animals and some sporadic human cases or even outbreaks were also reported. For these reasons this study was conducted to clarify the current status of brucellosis problem in Egypt and to provide the adequate data needed for occupational, veterinary and community health actions for management of this problem. The relevant data as regards to brucellosis in animals and human population [from 1983 through 1987] in Egypt were extracted mainly from the computerized data base, microfilms, documents and reports at the General Organization for Veterinary Service, Ministry of Agriculture and the Governorate's Veterinary laboratories. Other reliable sources e.g. the annual veterinary congress proceedings and the periodicals of veterinary association were also reviewed. The whole country was divided geographically into 4-main sectors, each one contains more than one governorate as follows: 1] Cairo and El-Sharkia, 2] Delta governorates, 3] Upper Egypt governorates and 4] Alexandria and Matroh governorates. The analysis of data pointed to the following main findings. The total number of positive human cases in the previously mentioned sectors were as follow: 25, 41, 64 and 15 respectively. In 1987 the infection rate in the tested animals were as follows: Upper Egypt 1.97 percent, Cairo and El-Sharkia 1.12 percent, Delta sector 0.66 percent and Alexandria and Matroh 0.44 percent and there is a positive correlation between the infection rate among animals and the positive human cases [r=0.954, P <0.05]. A pilot sero-epidemiological study was carried out by the authors during 1991 upon a randomly selected veterinarian group revealed that 70.8 percent of examined group was positive to brucella by tube agglutination test [titre > 1/80]. In conclusion, brucellosis represented a significant community health problem in our country. The above mentioned figures, underestimates the magnitude of the problem. The actual situation as well as control and preventive measures needs more organized efforts from different bodies

Serum uric acid in certain Egyptian groups an epidemiological study

A cross sectional study was carried out in Sharkia Governorate which involved estimation of serum uric acid in 196 individuals [125 from El-Abassa Village and 71 from the city of Zagazig]. Males above age of 15 years were found to have higher, serum uric acid levels than females both in urban and rural areas. Urban population as a whole showed higher serum uric acid level than villagers. Also those eating higher animal protein, obese subjects as well as hypertensive patients showed significant higher serum uric acid level than the others. On the other hand, no significant difference with social class, level of education, smoking habit and using of contraceptive pills

Low back pain in industry, an epidemiological study

This study was performed to determine the prevalence of low hack pain and the risk factors for this disease among the workers in jute industry. 484 workers were included from different sections at Belbis Jute factory in Sharkia Governorate. It was found that the prevalence of low back pain was 15.7% among manual workers in the factory while it was 7.1% among the administrative employees. Most of the diseased persons were above 40 years of age. This study revealed that the prominent risk factors for low back pain were age progression, long duration of employment and smoking habit. Low back pain prevalence was lower among workers practising spurt activities and those having higher educational levels. There was no significant relationship between low back pain and the worker's body mass index or his blood group

Compliance with seat belts as a personal protective measure among taxi drivers in Egypt

The use of preventive measures is an important indication of the extent to which both the health system and the community are committed to the promotion of health. Seat belt usage can provide the last line of defense when all possibilities of prevention of car accidents are exploited. For these reasons this work was intended to Document the current status of seat belt usage and to clarify the factors determining the compliance of taxi drivers with this personal protection activity. Three hundred professional drivers were randomly selected from a central car park in the greater Cairo and interviewed according to a questionnaire. The main results of this study were as follows: 1] 6% of interviewed drivers use seat belts regularly and 9.7% sometimes use it, whereas 84.3% do not use it at all. 2] The majority of seat a high-belt users are nonsmokers 70.2% [P < 0.05], and with er educational levels than non-users. 3] Interviewed drivers claimed that seat belts may be hazardous [30.8%], restrict movement [26.1%] or not useful in prevention of severe injuries [40.7%]. These data point to the need for comprehensive educational, legislative and training efforts to achieve a high seat belt compliance among this sector of workers

Knowledge, attitude and practice of private and governmental physicians in Zagazig in relation to diarrheal cases management

This study was performed to clarify the knowledge, attitude and practice of physicians about the different aspects of diarrheal cases management and to make benefit from oral rehydration therapy. The study included 204 physicians, 80% of them are working in urban areas in Zagzaig and 75% of those urban physicians received previous training courses on oral rehydration therapy[ORT]. The study reveated that 57% of physicians had high level of knowledge about ORT, 40% know the right indications of use of nasogastric tube and intravenous therapy. 37% of physicians had positive attitude towards treatment of dehydration by ORT. Urban physicians had higher attitude than rural physicians. As for feeding with rehydration, 70% of urban physicians recommended that scheme, while 40% only of rural physicians had the same attitude. In practice, 43% physicians did not use ORS in treatment of diarrhea. 4.9% use it alone and the rest use ORS with other medications. The causes of ORD limitations of use might be due to lack of knowledge, and training or confidence among doctors and mothers to use it alone

Cluster survey for vaccination coverage in Sohag Governorate, October 1989

This cluster survey for vaccination coverage in Sohag Governorate was carried out for the six vaccine preventable diseases in children below 2 years and tetanus toxoid for pregnant mothers. It reveals that vaccination coverage in Sohag is still far below the universal child immunization goal of 80% coverage by the year 1990. Fully vaccinated children were 17.2%. Vaccination coverage was better in urban [44.8%] than in rural areas [7%]. Vaccination coverage was higher in males [67.6%] than in females [32.4%]. Measles had the best level of coverage [66.1%] while B.C.G. was the least [20.9%]. Fifty percent of mothers were covered by two doses of tetanus toxoid. The most common reasons for drop out were unaware of need for return for second and third doses [32.6%] and vaccine not available [21.7%]. Evaluation of most important vaccination activities to be performed in link with the cold chain in the thirty health units of the thirty cluster areas of Sohag Governorate was performed

Knowledge, attitude and practice of pharmacists in Zagazig in relation to management of diarrheal cases with oral rehydration

This study was performed to identify the knowledge, attitude and practice of pharmacists concerning the different aspects of management of diarrhea with oral rehydration. It included 137 pharmacists in Zagazig district, about 32% of them working in rural areas. The study showed that 92% of pharmacists knowing the actual amount of water required to dissolve one packet of oral rehydration salts [ORS], 84% of them acquired their knowledge about oral rehydration from mass media and drug representative. Most of them [75.9%] have positive attitude toward, feeding of diarrhoeal cases. In the studied group 19% never prescribed ORS and the rest [81%] prescribed it. However only 4.4% prescribed ORS alone without other drugs which may reflect the lack knowledge or acceptance about ORS among the studied group

Some epidemiological features of addiction among industrial workers in Zagazig area, Sharkia Governorate

5378 industrial workers in Zagazig area were interviewed and examined by a questionnaire and urine screening for detection of drug dependence. These revealed 663 drug dependend workers [12.3%]. The latter group was further subjected to medical examination, liver function testing and personality scaling. The dependent workers were all males, relating mainly in the middle age group and with neurotic personality. The dependent workers were abused tobacco [45%], hashish [15.6%], caffiene [11.9%], simple analegesics [11.9%] and tobacco and caffiene [11.3%]. Alcohol and benzodiazepines were misused by 3.3% and 0.9% of addicts, respectively. The drug dependence had adverse effects on social life, general health and liver function of abusers when compared with control group. The drug dependent workers showed a higher mean value of days-off-work than non dependent. Moreover, the productivity and the quality of their work were adversely affected by their habit of drug abusing