Pattern of third molar impactions in north-eastern peninsular Malaysia: A 10-year retrospective study.

BACKGROUND: Third molar impaction, if left untreated, has the potential to cause several complications. The evaluation of surgical difficulty of impacted third molar extraction aids in better formulation of treatment plan by minimizing surgical complications. OBJECTIVE: This study aimed to determine the prevalence of third molar impaction and related pathologic conditions in a cohort of patients living in North-eastern Peninsular Malaysia. METHODS: In this retrospective study, 490 orthopantomograms (OPGs) of patients who were referred to the Oral and Maxillofacial Surgery department between January 2010 and December 2019 were assessed. Data including age, gender, ethnicity, frequency of third molar impactions, their angulations and levels of eruption, retromolar space, and associated pathologic conditions were collected. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.0. The significance level was set to P < 0.05. RESULTS: A total of 490 patients with a mean age of 28.87 years (range: 20-64) demonstrated 1957 impacted third molars (1022 mandibular + 935 maxillary). Impacted third molars were more likely present in females than males (1:2.20) (p < 0.05); and in Malay-ethnic (44.49%) patients followed by Chinese (34.45%) and Indians (21.02%). Mesioangular was the most common angulation of impaction both in the maxilla (24.68%) and mandible (18.34%). The most common pattern of third molar impaction was IIA (61.67%), and the retromolar space was significantly larger in males (13.6 mm; P < 0.05) than females (11.6 mm). The most frequently occurring pathological condition associated with third molars impaction is dental caries in the second or third molar (15.38%). CONCLUSIONS: This study highlights mesioangular impaction with their occlusal plane at the same level as the occlusal plane of the adjacent tooth being the most prevalent pattern of third molar impaction in North-eastern Peninsular Malaysia.

Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

OBJECTIVE: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. DESIGN: Quasi-experimental design with partial randomisation at the cluster level. SETTING: Seven rural districts in Zambia. POPULATION: Women delivering at 40 health facilities between June 2016 and August 2018. METHODS: Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. MAIN OUTCOME MEASURES: Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. RESULTS: We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001). CONCLUSION: The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit. TWEETABLE ABSTRACT: A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.

Access to asthma medicines at the household level in eight counties of Kenya.

BACKGROUND: It is estimated that about 4 million Kenyans, i.e., 10% of the country's population, have asthma. We aimed to evaluate access to asthma medicines at the household level in eight counties of Kenya, including factors associated with location of purchase. METHODS: Individuals with a diagnosis and prescription of asthma medicines were asked about the location of diagnosis, purchase of medicines, availability of medicines at home and costs of medicines per month. A logistic regression model explored the relationship between patient characteristics and the probability that the patient purchased asthma medicines at a public facility. RESULTS: Of 128 (15.2%) individuals with a diagnosis of asthma who were receiving treatment, only 57.0% had asthma medicines at home. The most frequently purchased asthma medicine was salbutamol, with one third of individuals taking it orally instead of by inhalation. The majority (55.4%) purchased asthma medicines at private pharmacies. Female patients and lower socio-economic status were predictors of purchasing asthma medicines at public facilities. CONCLUSIONS: The availability and affordability of asthma medicines remain significant barriers to access to care. Improving the availability and affordability of all asthma medicines in the public sector, including inhaled corticosteroids, offers the opportunity to reach vulnerable populations.

Decision-support systems in health care. Factors influencing the development and transfer of technology.

National concern about escalating health care costs and inefficiencies in delivery systems has created demand for informatics technology such as decision-support systems. This paper discusses the pressing need for better cost information in health care and how decision-support technology meets this need. Future directions for the technology also are discussed.

Primary health care in Senegal: lessons learned.

PIP: USAID began funding the Rural Health Delivery Services Project (RHDS) in Sine Saloum region (later divided into 2 regions--Kaolack and Fatick) of Senegal in 1977. Its aim was to improve the health of rural inhabitants and to set up a model health care delivery system. It specifically set out to increase agricultural output by reducing illness-related absence from work. USAID funds and local taxes paid for the construction of almost 400 village health huts, each staffed by a 1st aid worker and a traditional birth attendant. In 1982, 90% of villagers sought preventive and curative services from the health huts. In 1984, USAID extended funding to a 2nd phase of the RHDS II/Child Survival (CS) project which aimed to expand preventive health efforts and to introduce new preventive services targeting pregnant women and children. These services were immunizations, malaria control, oral rehydration therapy, and growth monitoring. Other objectives were to integrate these services and to institute program sustainability. Other agencies also were involved, such as UNICEF. RHDS II/CS successfully integrated several interventions at health hut and health post levels. An evaluation team found that the spirit of village-based primary health care made the RHDS system work. No follow-up survey to a 1982-83 baseline survey occurred, making it difficult for the team to determine whether RHDS II/CS achieved child survival goals. It recommended that teams have both expatriate and native representatives who are flexible and adaptable to local conditions and constraints and that agencies be pragmatic in their objectives and expectations about what evaluation teams can accomplish and provide advance documents to team members to allow them more of their often limited time in the country to do field work. The team called for donor agencies to cooperate on reporting requirements. It also suggested that new programs should be added to existing health systems and structures instead of forsaking previous successes.^ieng