A comparative study of the effect of health insurance on women's use of health facility delivery: Evidence from demographic health survey in Benin Republic

Studies in the Benin Republic have identified contextual factors that determine health facility delivery among women of reproductive age. However, it is not certain if the same set of factors predicts facility delivery for women who enrolled in health insurance and those who did not. The study seeks to compare the determinants of health facility delivery for mothers under health insurance and those that are not in the Benin Republic. The study used data for 33,078 women of reproductive age, drawn from the most recent Benin demographic and health survey (2017-18). The characteristics of the women were described using simple proportions and frequency. Binary Logistic regression was used to examine determinants of health facility delivery for both groups of women. The result showed that only 0.7% of the women were under health insurance coverage. The prevalence of health facility delivery was high in the enrolled group but not in the unenrolled group (98.3% vs. 87.8%). The uniform determinants of health facility delivery across the two groups were household wealth, education, employment, land/house ownership, media exposure, a minimum of four antenatal contacts, and place of residence. To improve the coverage of health facility delivery, a multi-pronged approach should be used to improve household socioeconomic status, encourage media use among women, expand education opportunities for women, and specifically target rural women in Benin. (Afr J Reprod Health 2022; 26[6]:104-115).

Tympanic membrane perforations secondary to blast traumaan experience of 74 affected ears

Objective: To determine the rate of spontaneous healing in different size of perforations and to analyze associated findings in cases of tympanic membrane perforations secondary to blast trauma

Study design: Retrospective Observational study

Place and duration: Department of ENT CMH Peshawar from 1[st] January 2009 to 31[st] December 2010

Patients and methods: Data of all patients diagnosed asblast induced 'tympanic membrane perforation' presenting from 1[st] January 2009 to 31[st] December 2010 was retrieved and analyzed. Depending upon size of perforation ie small, medium and large, cases were divided into three groups. All cases were managed conservatively for 3 months. Rate of Spontaneous healing, any surgical intervention and its outcome were analyzed in these three groups

Results: Fifty three patients with tympanic membrane perforation due to blast injury fulfilled the criteria to be included in this study. 32 [60.38%] patients had unilateral perforation and 21[39.62%] had bilateral perforation thus the total number of ears included in study was 74. Age range was 10 to 55 years with mean age 29.07+-8 years. Spontaneous healing was 94% in small perforations, 70.83 % in medium and 12.9 % in large perforations in three months' time

Conclusion: Further studies are required to find out the optimum time of surgical intervention to achieve best results in medium and large perforations

Delay in diagnosis and treatment of benign paroxysmal positional vertigo in current practice

More than 50% of the patients with peripheral vestibular disorders are suffering from Benign Paroxysmal Positional Vertigo [BPPV]. Diagnosis is established by positive Dix-Halpike test and/or roll test. Objective of this study was to analyse the delay in diagnosis and treatment of BPPV in current practice and to suggest measures to avoid this delay. One hundred and fifty two consecutive patients who were diagnosed and treated for BPPV in ENT department CMH Rawalpindi from Jan 2009 to Sep 2011 were selected for this study. All these patients were interviewed in detail regarding duration of vertigo, associated symptoms, visits to hospitals, investigations, treatment taken, cost of treatment and last or referral diagnosis before coming to our department. Out of 458 patients who presented with vertigo, 152 [33.2%] fulfilled the diagnostic criteria of BPPV. Male to female ratio was 1:1.17. Age range was 13-80 years and mean age 58.2 +/- 12.6. Posterior canal was affected in 96.7% and lateral canal in only 3.3%. Average duration between onset of first symptoms and diagnostic positional test was 19 months. One hundred and thirty eight patients have been visiting to general practitioners, various specialists, Homeopaths and Hakeems. Only 21% patients had visited to ENT specialists. 15.2% patients were already labelled correct diagnosis mostly by ENT specialists but Halpike test was done only in 8 patients and Epley's manoeuvre was tried in only four patients. 16.4% patients had undergone costly investigations like CT scan and MRI. Average cost on treatment before final diagnosis was Rs. 13,500 per patient. Particle repositioning procedure was successful in 84% patients in first attempt and 96% in two attempts. Though BPPV is a common and easily treatable condition, its diagnosis and treatment is delayed because of lack of awareness of this condition among doctors and patients. Clear understanding of the patho-physiology, diagnostic positional tests and canalith repositioning manoeuvre should be achieved through lectures and demonstrations

Comparative study - trans-septal basting suture vs nasal packing after submucoperichondrial resection

To compare the effectiveness of nasal packing vs basting [quilting] suture in the control of postoperative bleeding and or haematoma formation and patient compliance of nasal packing after Submucoperichondrial Resection [SMR]. Comparative clinical trial with stratified randomization. Department CMH Kharian cantt from January, 2006 to March, 2007. A total of 200 patients were included in the study. One hundred cases had basting suture and 100 had nasal packing. Patients requiring other procedures like cautery, submucosal diathermy, turbinectomy and middle meatal antrostomy were excluded. The two groups were compared for postoperative bleeding, septal haematoma formation, discomfort in nose, and general well being. Patients with basting suture were free of any discomfort postoperatively which was seen in cases with nasal packing. The two methods were equally effective in preventing excessive bleeding and septal haematoma formation. We conclude that the basting suture technique avoids the patient from post operative discomfort caused by nasal packing and is equally effective in preventing post operative septal haematoma. As the post-op discomfort is significant in nasal packing we recommend quilting of the mucoperichondrial flaps.

comparison of oral and topical steroid therapy for recurrent apthous stomatitis

This study was carried out to compare the efficacy of oral and topical Steroids in the treatment of Recurrent Apthous Stomatitis [RAS]. It was a quasi-experimental interventional study conducted on 60 patients of Recurrent Oral Ulcers seen in ENT Department of the Combined Military Hospital, Peshawar and Quetta, and was carried out in these hospitals from 01 August 2008 to 31 May 2010. Sixty patients, age ranging from 20 to 40 years; both genders were selected for the study purpose. The patients were included on the basis, having experienced oral ulcers at least thrice during the last one year severe enough to cause significant discomfort leading to absence from work place and remained afebrile during the ailment. Patients suffering from Hypertension, Bronchial Asthma, Glaucoma or Acid Peptic Disease were excluded. People taking medicines of any kind were not included in the study. Children, lactating mothers and pregnant females were excluded. Patients fulfilling the criteria were divided into two groups. Group I were given tablet Prednisolone [45mg] in daily divided doses for three days. Group II were prescribed topical application of Steroid[Triamcinolone acetonide] for the same duration. The day on which the treatment was started was counted as Day 1, the patients were re-examined on Day 2, 4 and 7. 91% of the patients of group I were symptom free on Day 4. Rest of the patients though not fully recovered were able to resume normal pattern of life. Only 47% of the patients of group II had comparable outcome on Day 4.On Day 7 all the patients of group I were normal while 18% of group II had some residual symptoms. Short term therapy of oral steroids brings an early and significant improvement in clinical picture of patients with RAS