Résumé
Setting : The tuberculosis control programme in Khon Kaen province, North East Thailand.Objective : To develop a tool for supervisor to easily assess the quality of screening for tuberculosis suspects in peripheral health units.Methods : Field exploration, tool development and field testing by researchers and health professionals.Results : A tested supervisor tool measuring the proportion smear positive tuberculosis suspects and the proportions suspects with two and three smears examined, indicative for screening performance. Defined acceptable levels of performance and remedial action to be taken.Conclusion : The tool is simple to use by the supervisors, is acceptable to supervisees and stimulates to self assessment and improvement.Key words : tuberculosis, tool, supervision, screening, district hospital
Résumé
Setting : Nineteen district hospital laboratories and a reference Zonal Tuberculosis control Centre laboratory in Khon Kaen, Thailand. Objective : To assess the performance of sputum smear examinations by peripheral laboratory technicians in their own work setting. Design : Exploratory study. 19 district hospital laboratories were asked to submit monthly a sample of sputum slides that were examined during 1990 and 1991. These slides were reexamined by a reference laboratory technician. The reading results were compared and the influence of slide preparation on the reading result was analyzed. Results : In a sample of 1057 slides the agreement in reading results between the reference and peripheral laboratories was 94% However, 39% of slides were not prepared well in sputum collection, smearing or staining. Among the slides with good sputum but with poor smearing or staining a significantly different proportion of positive slides were found compared with the well prepared slides when examined by the reference laboratory. The authors speculate that technicians in the district and reference laboratories make the same mistakes in reading these poorly prepared slides, so that a high agreement in results does not guarantee good performance. Conclusion : Not only agreement in reading results but also the proportion well prepared slides is and important indicator for peripheral laboratory performance. Keyword : tuberculosis, performance, sputum smear examination, district hospitalRequest for reprints :
Résumé
The northeast region of Thailand is suffering from an early but rapidly growing HIV/AIDS epidemic, particularly among rural people. Policies and programmes have been implemented at national level to deal with the country wide problem. This case study examines the situation at district level, and considers how well prepared doctors and nurses in district hospitals and health centres are to deal with the burgeoning epidemic. It assesses the knowledge, attitudes and practices of these health workers, and also local management polices and the cost impact of implementing universal precautions. A self-administered questionnaire was given to all 120 nurses in the distrit, and formal observations, using a check-list, were made of the hospitals and health centres. Indepth interviews were held with the directors of nursing, supply officers, nurse counsellors, and doctors. The attitudes and feelings of nurses were explored in focus group discussions. Results showed that though general knowledge about transmission of HIV and universal precautions was reasonably good, practices did not always reflect that knowledge. For example, needles were frequently recapped, and the rate of needlestick injury was extremely high (64% in the previous two years). Other gaps in some areas included confusion about disinfectant solutions, an proper disposal of infectious waste. There was no proper reporting and follow-up system for needlestick injuries. Nurses had a great fear of becoming infected in the workplace, and of being themselves stigmatised. In general this not lead them to avoid caring for infected patients. Rather, they showed great compassion for them. However, some nurses and doctor placed great reliance on knowing their patients HIV status, in the belief that it would enable them to better protect themselves. This sometimes led to compromise in the area of confidentiality. There is a keenly felt lack of support systems for nurses. While inservice training has taken place, nurse counsellors trained, and some homecare services in operation, there appears to be a lack of forward planning for the inevitable increase in demand on services for chronically ill patients and treatment of opportunistic infections. A clear picture of the cost impact could not be gained, and this also reflects a lack of planning capacity. Nurses and doctors in general perform very creditably in difficult circumstances. However, as a mater of urgency, authorities need to address a number of issues such as improved inservice training, implementation of proper procedures for needlestick injuries and waste disposal, and forward planning.
Résumé
An assessment of the use of traditional birth (TBAs) was undertaken in Phu Wiang District, Khon Kaen Province in Northeast Thailand form February to March 1992. The study was cross – sectional using a cluster random sampling scheme with probabiliry proportionate to size. According to official accounts, the utilization of TBA services by mothers has declined, particularly in their role as birth attendants and advisers on family planning. This study set out to substantiate this as well as find out what their new role is now. By questionnaire and in – depth interview it was ascertained that 31% of mothers with children under one had been delivered by TBAs. We found that overall, the utilization of TBAs by women before, during and after delivery were the following :- for anternatal care, 11.4% of mothers and pregnant women (n – 248) received either services or advice from TBAs. - for postpartum care, 35% of mothers (n = 183) were visited by TBAs.Overall , the proportion of all mothers in the sampled villages who received any advice or services from TBAs at any time last year, i.e. before, during, or after delivery was 49%.The fact that one – third of all deliveries were attended by TBAs in this study provides evidence that the TBA’s influence and acceptability continues to exist amingst people in remote rural areas even when formal health services are made available.
Résumé
The study was conducted among northeast Thai male population aged 35-64 years in Phondistrict of Khon Kaen. Sampled population was selected by cluster ampling by levels of development of villages. Data collected were including, demographic data, cigarrette smoking, socioeconomic status, blood pressure, body weight, height and total serum cholesterol. There were 209 men from 8 villages with the average age of 47.6 years. About three quarters of them were farmers. The prevalence of systolic hypertension (\> = 160 mmHg), diastolic hypertension (\> = 95 mmHg) were 1.4% and 2.4% respectively. Means (SD) of systolic, diastolic blood pressures and total serum cholesterol were 115.6 (15.3) mmHg, 75.7 (9.6) mmHg and 147.7 (35.3) mg% respectively. Smoking rate was 75%, Overweight (BMI \> 25 kg/m2) was only 17% of the population. Both mean systolic and mean diastolic blood pressures had significant correlation with both total cholesterol level and body mass index, as well as the level of development of the villages.