Performance of health providers in primary health care services in Jordan.

The study analysed time utilization by a sample of 111 physicians, nurses and midwives in 62 primary health care facilities in Jordan. The providers' activity over each shift was coded at 3-minute intervals using an activity sampling technique and patient-provider contact times were recorded. Overall, health providers spent the nearly half their time (48.7%) as down time' (waiting, breaks and non-work related activities), with 29.1% as clinical activities and 22.1% as non-clinical work-related activities. Physicians had higher clinical and down times than nurses and midwives; waiting for patients accounted for half the down time. The mean physician-patient contact time was 3.08 minutes. An appointment system is recommended to reduce down times for health providers and increase consultation times.

Reducing health care costs by rationalizing staffing in primary care settings.

Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar (JD) 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time (time not being used effectively) amounted to JD 9.7 million (about US$ 13.7 million). The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time.

Reducing health care costs by rationalizing staffing in primary care settings

Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar [JD] 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time [time not being used effectively] amounted to JD 9.7 million [about US$ 13.7 million]. The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time

Performance of health providers in primary health care services in Jordan

The study analysed time utilization by a sample of 111 physicians, nurses and midwives in 62 primary health care facilities in Jordan. The providers' activity over each shift was coded at 3-minute intervals using an activity sampling technique and patient-provider contact times were recorded. Overall, health providers spent the nearly half their time [48.7%] as down time' [waiting, breaks and non-work related activities], with 29.1% as clinical activities and 22.1% as non-clinical work-related activities. Physicians had higher clinical and down times than nurses and midwives; waiting for patients accounted for half the down time. The mean physician-patient contact time was 3.08 minutes. An appointment system is recommended to reduce down times for health providers and increase consultation times

Patient expectation and satisfaction in different hospitals in Irbid, Jordan.

OBJECTIVE: This study attempts to identify factors contributing to patients' satisfaction and to examine the relationship between patient satisfaction and patient expectations. METHODS: The study sample consisted of 360 patients randomly drawn from the outpatients' practice of 2 health centers in Irbid, North Jordan; a university and governmental one. Patients' satisfaction was assessed using a self-administered patient satisfaction questionnaire. Patients' expectations were assessed by exposing patients to a series of video clips showing pre-tested patient provider encounters. RESULTS: On average, users of the Community Health Center had lower expectation levels and higher satisfaction means when compared to users of the University Health Center. The study results showed that patient satisfaction was mainly influenced by patient expectation of received care even after adjustment for socio-demographic variables. CONCLUSION: This study therefore, argues that while assessment of patient satisfaction is useful as a monitoring indicator for overall health care delivery performance, still interventions are required to improve the delivered care. There is a need to examine client expectations and tailor services accordingly since satisfaction measures can only diagnose a problem while expectation assessment can identify clients needs and thus program managers can better design health services delivery.

Can a home-based pelvic examination be used in assessing reproductive morbidity in population-based studies? A Jordanian experience.

RATIONALE: Most estimates of reproductive morbidity in a community are derived from health service-based studies. However, these numbers do not reflect the actual magnitude of the problem because of barriers to health care and differences in health-seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a Jordanian community. OBJECTIVE: To assess the validity of a home-based pelvic examination in detecting signs of reproductive morbidity when compared with a clinic-based examination. METHODOLOGICAL DESIGN: Descriptive study in which women were randomly selected from the study area to participate in the study. RESEARCH METHODS: Three hundred and seventy nine women, 18 years and above were randomly selected, and general and pelvic examinations were conducted in each woman's home. Thirty-two of these women were again randomly selected and consented to a second pelvic examination in a clinical setting. INSTRUMENTS: Two trained female obstetricians conducted the pelvic examination which included examination of the vulva, examination of the vagina and a bimanual examination. Outcome measures. Strength of association between the presence or absence of physical signs of reproductive morbidity detected by the home-based pelvic examination and the same signs identified by the clinic-based examination, deemed in this study as the 'truth'. RESULTS: The overall sensitivity, specificity, positive and negative predictive values of the home-based pelvic examination were 66, 86, 69 and 84%, respectively. STUDY LIMITATIONS: The sample size was small, so further studies are recommended to replicate the findings here. CONCLUSIONS: Results suggest home-based pelvic examinations can be used in population-based studies for a comprehensive assessment of women's reproductive morbidities.

The magnitude of osteoporosis in middle aged women.

OBJECTIVE: This study aims to increase the body of knowledge regarding osteoporosis in the Jordanian context by investigating the magnitude of osteoporosis amongst perimenopausal women, as well as the risk factors associated with the disease. METHODS: Two hundred and fifty one women between the ages of 40 to 60 years were randomly selected from the Orthopedics and Rheumatology out patient clinics at the Major Teaching Hospital in Amman, Jordan. A structured questionnaire, which focused upon risk factors and preventive measures for osteoporosis, was administered by a trained staff nurse to all women. Index women were then referred to a private hospital, also in Amman, for a dual energy x-ray absorptiometry of the lumbar spine (Lumbar 1-4) and hip. RESULTS: Results show the magnitude of osteoporosis was 13% according to the bone mineral density of the lumbar spine. Women with osteoporosis were older (p< 0.00) and smaller in build (p<0.00) than women with low or normal bone density. Osteoporotic women were also more likely to be menopausal (p<0.00) and to have taken corticosteroids for a prolonged period of time (p<0.00). Logistic regression showed being menopausal (p<0.00), taking corticosteroids (p<0.05), and having a relatively lower body mass index (p<0.00) were significantly related to being osteoporotic in this group of women. CONCLUSION: The authors conclude that this study was not only able to report upon the magnitude of osteoporosis among women sampled, and the risk factors for low bone density, but also raised issues related to inconsistencies in how the health care system deals with women who are at risk for osteoporosis. Study findings are discussed in their socio-cultural context, and implications of the study findings are presented.

The effect of type of hospital and health insurance on hospital length of stay in Irbid, North Jordan.

The study aimed at examining the effects of type of hospital and health insurance status on hospital length of stay for three identified medical and surgical conditions. Medical records of 520 patients for the year 1991 were reviewed in one public and one private hospital. Comparison of hospital length of stay for the private (n = 185) versus public sector patients (n = 335) was carried out. The effect of presence of health insurance (n = 189) and the lack of it (n = 325) was also studied. It was found that the average length of stay in the public hospital was significantly longer than the private one (3.3 versus 2.7 days). In addition, insured patients had significantly longer hospital length of stay (3.3 versus 3.0 days). The results of the multi-variate analysis showed that after socioeconomic factors and clinical conditions of patients were adjusted for, the influence of hospital type and health insurance on hospital length of stay was about one day. The paper also discusses the need to base hospital cost-containment strategies on studies of hospital behaviour and performance.

The assessment of reproductive health services: a conceptual framework for prenatal care.

This article delineates a conceptual model for defining and measuring quality in prenatal services. It addresses three issues related to women's health: (a) the emerging interest in reproductive health as a concept that encompasses the full range of women's needs, versus the more narrow concept and approach of traditional maternal and child health services; (b) the importance of prenatal services within the context of reproductive health, particularly in developing countries; and (c) the positive role that quality plays in promoting women's health. It then proposes a model for defining and measuring quality in prenatal services, styled after Donabedian's work and informed by Bruce's framework. It assesses the quality of prenatal care in terms of five elements: management, pregnant woman-provider relations, technical competence, information transmission, and continuity of care. The framework was tested in the city of Irbid, Jordan, in 1992. Findings are summarized, and recommendations for future work as discussed.

PIP: The authors consider the following issues related to women's health: the emerging interest in reproductive health as a concept which encompasses the full range of women's needs, versus the more narrow concept and approach of traditional maternal and child health services; the importance of prenatal services within the context of reproductive health, especially in developing countries; and the positive role which quality plays in promoting women's health. The authors then propose a model for defining and measuring quality in prenatal services, styled after Donabedian's work and informed by Bruce's framework. The model assesses the quality of prenatal care in terms of the following elements: management, pregnant woman-provider relations, technical competence, information transmission, and continuity of care. The framework was tested in Irbid, Jordan, in 1992. Recommendations are presented for future work.

Growth patterns of jordanian children: a national study.

This study examined the growth patterns of Jordanian children below three years of age in comparison with the NCHS reference population. Weight and length measurements of 1224 boys, and 1120 girls were obtained from a national multipurpose study of Jordanian preschool children carried out in 1984. The study results showed that children of both sexes grew at Gentiles that were close and parallel to the NCHS in the first quarter of the first year. However, both weight and length Gentiles departed from the NCHS counterparts later on with length showing marked differences from the reference. The differences observed between the local and the NCHS reference population suggest that the NCHS should be used as a target for planning and evaluation of' intervention programs at a national level while the need for the local standards to assess individual cases remains a necessity.

In vitro activities of antimicrobial agents against Proteus species from clinical specimens.

Two hundred clinical isolates of members of the genus Proteus were definitively identified and their antimicrobial susceptibilities to 12 antimicrobials tested, 176 isolates (88%) being identified as Proteus mirabilis, 12 strains (6%) as Proteus vulgaris and 12 strains (6%) as Proteus penneri. Most strains were isolated from pus (62.5%) and urine (34%), but in general there were no significant differences in the rates of isolation of any of the species by age or sex, although it was noted that P. vulgaris was only isolated from patients belonging to the older age group (> 5 years). The Proteus spp. were notably susceptible to nalidixic acid, ceftazidime and the aminoglycosides tested, and resistant to polymyxin B and colistin. The inclination of certain Proteus species to be susceptible or resistant to certain antimicrobials was noted, but strain differences also existed. The results of the study confirm the importance of performing antimicrobials susceptibility testing of each Proteus isolate to avoid potentially misleading therapy. The noted discrepancy in the result of the susceptibility of P. penneri to chloramphenicol as tested by different standard methods merits further investigation.

Assessment of the managerial functions in primary health care settings.

PIP: During October 1988 to June 1990, the authors developed a conceptual framework with which to measure the quality of prenatal care in primary health care (PHC) settings. That framework was applied during June-December 1990 to the public maternal and child health facilities in the Irbid Governorate of North Jordan which provide prenatal care. Management is an essential component of quality prenatal care. The authors describe the indicators of the managerial functions practiced in the PHCs and report upon the extent to which they are performed. Management was analyzed at the levels of both structure and process. The 31 managers of the PHCs providing prenatal care in the Irbid Governorate were interviewed about their various management functions. General information was also collected on the personnel and facilities available at the centers. The managers were of mean age 37 years with an average 2 years of experience managing their facilities. The managers in all but two facilities were male physicians. Study findings suggest that the management functions of prenatal care services in PHC settings are inadequately performed. The indicators suggest that the controlling function was better performed than the planning, organizing, and directing functions.^ieng

Assessment of the quality of prenatal care: the transmission of information to pregnant women in maternal and child health centers in jordan.

The quality of information provided to pregnant women seeking prenatal care from public maternal and child health (MCH) facilities was assessed in Irbid, the principal city in the North of Jordan. The structural setup of the settings, as well as the process of information transmission, were examined using interviews of the managing physicians and recipients, as well as observation of encounters between pregnant women and health care providers (physicians and midwives) at the health facility. The results of the study showed that pregnant women's needs for health information were not being adequately met Women were dissatisfied with the quality of information delivered. Inadequacies in both the structure and the process of information provision are discussed.

The role of day care givers in the identification and prevention of infections.

The prevalence of nasopharyngeal Streptococcus pyogenes in children attending day care centers in North Jordan was studied. Nasal and throat swabs, cultured for Streptococcus pyogenes were collected from 100 children enrolled in four day care centers serving middle to high socioeconomic status portions of the population in March 1989. The identity of the streptococcal isolates was confirmed by biochemical and serological methods. Throat infection manifestations of the past 3 days, as reported and observed by the care givers, were related to culture results. The study findings showed that the prevalence of nasopharyngeal Streptococcus pyogenes was high and ranged between 10 to 23.3%. It was also noted that the care givers were able to correctly identify children with suspected throat infection, in 11 to 25% of the children who grew Streptococcus pyogenes on cultures, by mere observation of the symptoms. Due to the high prevalence of nasopharyngeal Streptococcus pyogenes in these settings, measures to control and prevent the spread of Streptococcus pyogenes must be employed. This study suggests that care givers may play an important role in achieving such a goal if they are offered proper health education programs and instructions on child hygiene.