Abortion quality of care from the client perspective: a qualitative study in India and Kenya.

Quality healthcare is a key part of people's right to health and dignity, yet access to high-quality care can be limited by legal, social and economic contexts. There is limited consensus on what domains constitute quality in abortion care and the opinions of people seeking abortion have little representation in current abortion quality measures. In this qualitative study, we conducted 45 interviews with abortion clients in Mumbai, India, and in Eldoret and Thika, Kenya, to assess experiences with abortion care, definitions of quality and priorities for high-quality abortion care. Among the many aspects of care that mattered to clients, the client-provider relationships emerged as essential. Clients prioritized being treated with kindness, respect and dignity; receiving information and counselling that was personalized to their individual situation and reassurance and support from their provider throughout the entire abortion process, including follow-up after the abortion. Many clients also noted the importance of skilled providers and appropriate care. There were similarities across the two country contexts, yet there were some differences in how clients defined high-quality care; therefore, specific political and cultural influences must be considered when implementing measurement and improving person-centred quality of care. These domains, particularly interpersonal interactions, should be prioritized in India and Kenya when health systems, facilities and providers design person-centred measures for quality in abortion care.

Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness.

INTRODUCTION: Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors. METHODS: The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables. RESULTS: Medical providers included doctors, their employees and medical insurance providers. Most doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient. Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient. CONCLUSION: The study showed that medical providers and patient awareness had influence over day surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.

Fournier's ganrene in the HIV era.

BACKGROUND: Fournier's gangrene is a devastating condition that affects mostly patients whose immunity has been reduced. There is increasing evidence for increasing incidence of the disease in those with HIV disease. OBJECTIVE: To evaluate the presentation, bacteriology and outcome of Fournier's gangrene in our area in recent times in view of the high prevalence in Nairobi and its environs. RESULTS: One hundred and forty six patients were treated for Fournier's gangrene during the study period; all were male. They had a mean age of 38.6 years (range 2 months - 86 years). HIV infection was the most common associated underlying illness (16.4 %), followed by diabetes mellitus and alcoholism (11%). CONCLUSIONS: HIV infection is emerging as leading predisposing factor and has overtaken diabetes in predisposing for Fournier's gangrene in Kenyatta National Hospital.