Creation of Public Health Cadre in Karnataka State, India.

Background: Public Health is the science and art of promoting Health, preventing diseases and prolonging life through organized efforts of Society. The Government of Karnataka constituted a committee to revive the Public health system in state of Karnataka to provide recommendations for creation of Public health ca-dre. Objectives: To provide recommendations for creation of efficient public health system through creation of public health cadre. Methods: We reviewed several documents for studying the history and current struc-ture of the department regarding creation of public health cadre/department. We conducted 35 brainstorm-ing sessions involving in-depth discussions. We also conducted field visits and administered a pre-designed format for collecting the feedbacks from the officials of different levels. Results: The reviewed documents had a common finding of implementing public health cadre. Our analysis of current human resources in health department indicates that there is shortfall of qualified public health professionals in the department to opt and continue in public health cadre. Among the existing staff, 51% of the respondents wanted to up-date their skills through continued professional education. Our results from the study demonstrated to create a Public health directorate and public health cadre in Karnataka state. Conclusions: We recommend that there can be three levels in Public Health Cadre namely, Taluk level officers, District level officers and State level officers. We recommend time bound promotions of medical officers in accordance with published and updated common seniority list, which is the basis for all service matters.

XDR-TB: An outcome of programmatic management of TB in India.

A significantly strengthened Revised National Tuberculosis Control Programme (RNTCP) is currently operational in India. In this case-based commentary, we describe the plight of a patient who developed extensive drug-resistant tuberculosis (XDR-TB) despite having received treatment under the RNTCP for a long period. Our aim is to analyse the programmatic management of tuberculosis in India by highlighting and discussing various issues related to the treatment received by the patient. Further, the article explores whether there is a need to incorporate an ethical element into the RNTCP as it stands today.

Modelo multidimensional para o controle da dengue: uma proposta com base na reprodução social e situações de riscos / Multidimensional model for dengue control: a proposal based on social reproduction and risk situations

O objetivo do artigo consiste em apresentar e discutir um modelo compreensivo/explicativo, de caráter ecossistêmico, sobre o processo de transmissão da dengue nos níveis de micro e macrocontexto, a partir da identificação das situações de riscos envolvidas. Considerou-se a dengue como doença infecciosa viral de transmissão vetorial que traz, na sua dinâmica de transmissão, elementos das dimensões biológicas, de conduta, ecológicas, políticas e econômicas, o que a caracteriza como um problema complexo e exige um enfoque sistêmico para seu controle. Assim, para a construção da modelagem, utilizaram-se o enfoque teórico da reprodução social de Juan Samaja e seus condicionantes de macro e microcontexto, e o enfoque operativo ecossistêmico, que buscou responder à pergunta condutora desta construção: quais são as situações de risco para transmissão da dengue, considerando as diversas dimensões da "reprodução social da saúde" no nível local? A visão ampliada das inter-relações entre as diversas situações de risco envolvidas na determinação multidimensional da dengue poderá servir como eixo direcionador para uma gestão integrada das ações do programa de controle da doença, articuladas entre os diversos setores envolvidos.

This paper aims to present and discuss a comprehensive / explanatory model, of ecosystem approach, on the process of transmission of dengue in the levels of micro and macro context, from the identification of the risks involved. Dengue was considered a viral infectious disease of vectorial transmission that carries on its transmission dynamics, elements of the biological, behavioral, ecological, political and economic dimensions, that make it a complex problem and require a systemic approach to its control. Thus, for the construction of modeling, we used the theoretical framework of social reproduction of Juan Samaja and its conditions of macro and micro-context, and the operating ecosystem approach, which sought to answer the question driving this construction: what are the risk situations for the transmission of dengue, considering the different dimensions of "social reproduction of health" at the local level? The enlarged view of the interrelationships among the various risk situations involved in determining multidimensional dengue could guide the integrated management of actions of a disease control program, coordinated by the several sectors involved.

Princípios e padrões em metaavaliação: diretrizes para os programas de saúde / Principles and standards in metaevaluation: guidelines for health programs

Este artigo apresenta questões imperativas para o uso de princípios e padrões em avaliação, permitindo destacar diretrizes para estudos de metaavaliação, tendo como exemplo os Estudos de Linha de Base (ELB) do Projeto de Expansão e Consolidação do Saúde da Família (Proesf). Essas questões são importantes em países em que a Política Nacional de Avaliação ainda é incipiente, como é o caso do Brasil, onde se observa a ausência de dispositivos legais, diretrizes, ou parâmetros que busquem claramente garantir a qualidade, credibilidade e reconhecimento da prática da avaliação. Apresenta-se uma breve revisão da literatura sobre princípios e normas que fundamentam as diretrizes gerais formuladas para uma metaavaliação formativa dos estudos de linha de base, orientada pela aplicação dos quatro padrões internacionais para avaliação das políticas sociais: utilidade, exeqüibilidade, propriedade e precisão, que têm igualmente servido de guia para o desenho dos estudos de avaliação de programas de promoção e proteção à saúde, aos quais se associam padrões de especificidade definidos por uma técnica de consenso mista baseada nas prescrições do Termo de Referência dos ELB. O principal interesse é incentivar o amplo uso dessas ferramentas na avaliação em saúde como um ponto crucial para aperfeiçoamento e desenvolvimento do SUS.

This article poses questions imperative for the use of principles and standards of evaluation allowing for pointing out directives for meta-evaluation on the example of the Baseline Studies (BLS) of PROESF. These questions are important in countries like Brazil, where a National Evaluation Policy is still in its beginning, and where one observes absence of legal devices, directives or parameters clearly seeking to ensure the quality, credibility and recognition of the practice of evaluation. We present a brief review of the literature about principles and norms constituting the bases for the general directives formulated for a formative metaevaluation of the baseline studies, oriented by the four international standards for evaluation of social policies ­ utility, feasibility, propriety and accuracy. The same standards were used for guiding the design of studies for evaluating health promotion and protection programs, together with specificity standards defined by a mixed consensus technique based on the prescriptions of the Terms of Reference of the BLS. The main interest rests in encouraging a broad use of these evaluation tools in the field of health, as a crucial point for its improvement and the development of the Unified Health System.

Assessing prescribing and patient care indicators for children under five years old with malaria and other disease conditions in public primary health care facilities.

A prospective descriptive observational study using WHO indicator forms and questionnaire was carried out in Kibaha district public primary health care facilities. We assessed knowledge about drugs in mothers/guardians of sick children under age five years immediately after consulting clinicians and after receiving drugs from the dispenser. The questionnaires had closed- and open-ended questions. Interviews were administered by trained nurses and the authors. The prescribing, dispensing practices, including drug labeling and instructions given to mothers/guardians on how to use drugs at home, in these health facilities which are under the Essential Drugs Program (EDP), was assessed. A total of 652 prescriptions from mothers/guardians with sick children under age five years were observed, recorded and analyzed. Prescribing indicators were used as stipulated by the WHO/DAP/93.1 how to investigate drug use in health facilities. The diagnosis for malaria cases made by the clinicians on average per facility were as follows: malaria alone 25, diarrhea alone 3, pneumonia alone 3, malaria and diarrhea 4 cases, malaria and pneumonia 2 cases and malaria and other conditions 14 cases. The average number of drugs per prescription in these facilities was 2.3 and the percentage generic prescribing was 87.0, antibiotics 30.5, and injections 26.2, with 93.5 % of all prescribed drugs being within the Essential Drugs List (EDL). The overall average dispensing time was 1.4 minutes per patient, of the drugs prescribed, 54.7 % were dispensed, whereas 21.4 % of drugs dispensed to mothers/guardians were adequately labeled, and 37.2 % of mothers knew how to administer drugs correctly to their sick children after receiving the drugs from the dispenser. These results suggest the need for educational intervention for prescribers (health care providers) on rational prescribing of drugs, such as antimalarials, antibiotics, injections, proper dispensing, and adequate labeling drugs in packets, while the dispensing time for drugs was too short. It is necessary to correct these malpractices of irrational prescribing and dispensing drugs for treatment of malaria and other childhood illnesses in public primary health care facilities (PHC). Furthermore, inadequate physical examination and short consultation time needs to be improved. There is a need to advise the Ministry of Health to develop health education programs on a regular basis for all health care providers in the country and mothers/guardians of children in general public/rural communities on how to use/administer antimalarials and other drugs at home. All these can be achieved through well planned health education training programs.

Percepción de profesionales de la salud sobre las funciones esenciales de salud pública / Perception of health professionals on essential public health functions

Pregunta de investigación: ¿Cual es el cumplimiento de las funciones esenciales de salud pública por el Ministerio de Salud y Deportes?. Objetivo: Medir la opinión de profesionales de la salud sobre el grado de desarrollo de las funciones esenciales de salud pública como responsabilidades del Ministerio de Salud y Deportes. Diseño: Estudio de opiníon, exploratorio, transversal y descriptivo. Método: Encuesta anónima y autoadministrada. Resultados: El valor promedio asignado a cada función esencial está alrededor de 5 sobre 10 puntos, que indica un desempeño regular.

Assessment of care for type 2 diabetic patients at the primary care clinics of a referral hospital

There is rapid increase in the incidence of Diabetes Mellitus [DM] in the Kingdom of Saudi Arabia [KSA], as in other countries. An optimal care of diabetic patients depends on the health care providers as well as the type of health care setting. Due to the severity of chronic complications in Type 2 diabetic patients, it is essential to assess both the practices of the providers and the patient outcomes at any clinical setting. To assess the screening patterns7 of diabetes associated health care problems in primary care clinics of King Khalid University Hospital [KKUH] and while compare them to the current diabetes clinical practice recommendations of American Diabetes Association [ADA]. The retrospective review of charts of 103 eligible patients who attended the primary care clinics of KKUH over a 3 year-period [1/12001-31/12/2003] had provided 99 type 2 diabetic patients. The study variables included demographic data, complications, treatment, the provider screening practices [measurements of HbA1c, BP, Lipid profile, number of eye and foot examination]. From these data, the frequency of provider screening tests, normalized by patient-year could be compared with the ADA guidelines. The mean age of 99 type 2 diabetic patients was 57 years, with a mean BMI of 30.8 kg/m2 and with a mean duration of diabetes of 11.8 years. Many had comorbidites or complications: 25% had retinopathy, 17.2% had nephropathy, and 12.1% had neuropathy. The HbA1c level of /= 1 lipid profile, during their follow-up period. During 2[nd] and 3[rd] year follow up only 30% had >/= 1 HbA1c measurement and 26.5% [at 2[nd] year], 22% [at 3[rd] year] had >/= 1 foot examination. The proportion of patients, who had >/= 1 eye examination was also reduced during their follow up. The provider practice screening results per patient-year was well below the specified guidelines of ADA. Type 2 diabetic patients care at our primary care clinics did not adhere to the guidelines of ADA. The reasons for the deficiencies were not evident from this study. More detailed studies are needed to find out the relevant causes for the lack of adequate diabetic care at primary care clinics

Knowledge and practices of childhood immunization among primary health care providers in Riyadh city: part II - precautions and contraindications to vaccination

To assess 1] how aware those who administer vaccines in the primary health care centres [PHCs] are of the appropriate precautions and contraindicaitons of vaccines and 2] the extent to which their practice complies with standards, and 3] the correlation between the levels of knowledge and practice on one hand with the duration of practice and attendance at a training course on vaccination on the other hand, for physicians and nurses separately. A self-adminstered questionnaire including 16 statements related to knowledge and practice of precautions and contraindications of vaccines was distributed among workers in 50 MOH PHCs in Riyadh. 506 questionnaires were returned, only 331 were completed for this part of the study giving a response rate of almost 65%. However, the statement-specific response rate varied. Except for a few, most statements were correctly responded to by a majority of the respondents reflecting adequate knowledge and appropriate practice. Experience in dealing with vaccination, and formal training in vaccination were not statistically significantly associated with the responses of both physicians and nurses. Inspite of the limitations of this study it could be fairly concluded that the overall knowledge and practices regarding precautions and contraindications of childhood immunizations among the primary care providers surveyed was good. Significant gaps still exist. This underlines the need for continuous training and supervision of health care providers who deal with the immunization of children

Protocolo de conduta: educação e prevenção em saúde para o enfrentamento da escabiose em pré-escolares / Conduct protocol: education and prevention in health for facing scabies' disease in pre-school

O objetivo principal deste trabalho és estabelecer uma visão multidisciplinar sobre a escabiose, que é um problema endêmico no Brasil, analisando sob os aspectos sociais, e com orientações na linha preventiva com fluxograma e protocolo de conduta.

Assessment of community maternal care performance of public health midwives of a province in Sri Lanka: a multi-method approach.

The maternal care performance of public health midwives' (PHM) was reviewed using 4 methods in a province of Sri Lanka. The objectives of this descriptive study were to provide a comprehensive assessment of their work and to determine the use of a multi-method system to assess their performance in terms of self- assessed competency, knowledge, attitudes and performance of domiciliary and field clinic services. There were 301 (87.2%) PHMs with good or moderate level of knowledge in antenatal care with only 165 (47.8%) and 238 (69.8%) in natal and postnatal care, respectively. Total knowledge decreased with increasing age and duration of service. Self-assessed competencies were high but not positively correlated with actual knowledge. Attitudes were found to indicate dissatisfaction with the job and a preference of clinic services at the expense domiciliary care. The results indicated that continuing education and enhancement of career prospects were necessary. The methods used in this study could be adopted with appropriate modification for evaluation of personnel in similar settings.