Role of antenatal care in toxemia of pregnancy in Alexandria

Pre-cclampsia and eclampsia remain one of the major obstetrical problems in less developed countries. Proper antenatal care [ANC] with regular measurement of blood pressure remains the mainstay of screening for hypertension in pregnancy. The aim of the current study was to identify frequency and characteristics of women with toxemia of pregnancy, assess both the quantitative and qualitative adequacy of antenatal care among cases with toxemia of pregnancy and to evaluate the effect of antenatal care on maternal and perinatal outcome. A cross-sectional case series study design was utilized. The study population was all cases, with confirmed diagnosis of toxemia of pregnancy who were admitted to El-Shatby University hospital during the period from January to May 2005. A structured interviewing schedule was used to collect data on characteristics of cases, maternal and fetal outcome. Site, adequacy and quality of received antenatal care were assessed. Out of total cases [336], 14.29% were diagnosed as mild pre-eclampsia, 83.31% were found to have severe pre-eclampsia while 2.40% were suffering from eclampsia. The severity of the condition was significantly associated with older maternal age, multiple pregnancy, primigravity, nulliparity, low socioeconomic conditions, husband's smoking and excessive caffeine consumption. Three-quarters of eclampsia cases [75.0%] didn't receive antenatal care and 60.0% of severe pre-eclamptics received inadequate antenatal care. The mean percent score of quality care domains of antenatal care content for mild pre-eclamptics was 75.62 +/- 13.80%. This was significantly higher than that for those of severe [59.96 +/- 27.95%] or for eclampsia cases [48.75 +/- 20.04%] where X2 of Kruskal-Wallis=8.316 [F<0.001]. Adverse maternal and fetal outcome occurred in 79.4% of women and 72.3% of babies for those who received poor quality ANC. In conclusion, the complications of pre-eclampsia and eclampsia could be prevented by wide spread use of adequate antenatal care, education and training of primary medical care personnel, prompt diagnosis of high risk patients and timely referral to higher level health care

conformity of physicians' performance with the national guidelines of the Egyptian family planning program

Data on adequacy of physicians' performance at family planning clinics in Alexandria is contained in this report. An observational check list was used for monitoring the daily performance of 35 physicians working in the 12 family planning clinics of Alexandria. Clients were intrauterine device users in their initial visits to the clinics. The whole care process was divided into five areas covering interpersonal communication and technical aspects. The percentage score [physicians' performance index] was calculated for total, area and sub-areas of care. The collective performance index combines indices of physicians in both types of facilities together. Fifty percent value of physician performance index was taken as the cut-off point between lower unacceptable performance and higher acceptable one. The collective total performance index was unacceptable [49.37 +/- 8.24] denoting considerable deviation from standards of adequate care. Areas of care related to examination and history taking tasks had the most deficient collective physician performance index [6.72 +/- 6.64 and 25.56 +/- 13.03 respectively]. Negligence of these two areas skips the two basic rationales for right choice of the contraceptive method. The collective performance index for communication was just above the acceptable value [51.20 +/- 13.37]. The two areas with highest performance index were infection control and intrauterine device insertion [63.36 +/- 10.79 and 65.66 +/- 12.08 respectively]. This is an indication of the technical orientation of physicians leaving the total program concepts like informed decision and continuation inadequately implemented. Performance index of physicians in specialized clinics was repeatedly found to be significantly higher than those of integrated clinics in all areas of care. In area of communication, the performance index in specialized clinics was acceptable in contrast to that in integrated ones. However, the performance index in the two types of clinics were found together in either the acceptable or the unacceptable range in all other areas. This may reflect the existence of a dominant atmosphere that enhances or weakens the performance in different areas of care and the priority of importance given to these areas

Quality assessment of medical care in chest dispensaries in Alexandria

Eight million new cases of tuberculosis are merging annually, worldwide, of which an estimated three million are dying. The quality of medical care rendered by chest clinics [dispensaries] to tuberculous patients is crucial. The present study was conducted in order to assess quality of medical care rendered to tuberculous patients in all chest clinics in Alexandria [n=7]. To achieve this aim, three checklists were developed in relation to the three dimensions of medical care, namely, structure, process of care and outcome. They were validated and rated by ten medical experts working in the field of tuberculosis and chest diseases. Accordingly for the process of care, each item was scored using weighted scores for physicians performance. Unit weighted scoring was also used for physicians, nurses, as well as social workers. Direct observation was conducted for assessment of structure and process of care rendered by physicians, nurses and social workers. On the other hand outcome was measured by cure or treatment completion rate, treatment failure rate, defaulter rate, as well as death rate. The results revealed that percentage of recommended structure items ranged between 77.8% and 94.4%. Regarding process of care, it was found that the overall weighted physicians performance index [PPI] expressed in percentage was 36.97 +/- 13.65% while the mean unit weighted PPI was 35.26 +/- 13.5%. For the different areas of care, the mean weighted and unit weighted PPI, respectively, were 27.86 +/- 20.83% and 28.61 +/- 21.7% in history taking, 54.65 +/- 11.92% and 42.83 +/- 13.83% for examination, 31.64 +/- 19.61% and 37.10 +/- 19.40% for educating patients, while it was 36.36 +/- 16.0% and 37.90 +/- 16.20% for measures applied to contacts. Moreover, assessment of nurses and social workers performance revealed that they had carried out 91.86% and 86.60% of their recommended activities, respectively. Outcome indices among the different clinics showed that cure or treatment completion rate ranged from 47.48% to 81.51%, while treatment failure rate ranged between 1.71% and 11.54%. On the other hand, the defaulter rate showed a minimum of 13.70% and a maximum of 44.86%. From the present study it could be recommended that quality of medical care in chest clinics should be emphasized specially as regards process of care given by physicians