Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia

The study examines the association of unwanted pregnancy and the utilization of maternal-child health services, and the adverse health outcomes in urban and rural settings. The study employed data from the 2017 Indonesia Demographic Health Survey that included 13,806 live births; the mothers were not pregnant at the interview and were married participants. The multiple logistic regression analysis concerning residential areas was conducted separately to compare outcomes related to unwanted pregnancy. Non-standard antenatal care visits (adjusted odds ratio [AOR]=1.7; 95% confidence interval [CI]=1.2–2.4), prolonged labor (AOR=1.6; 95% CI=1.2–2.1), the absence of child’s birth documentation (AOR=1.3; 95% CI=1.0–1.6), and smaller baby size (AOR=1.2; 95% CI=1.0–1.4) are associated with unwanted pregnancy in urban areas. In rural settings, on the other hand, unwanted pregnancy is associated with non-standard antenatal care (AOR=1.6; 95% CI=1.2–2.2). Therefore, in Indonesia, urban areas lack maternal-child healthcare services utilization and higher adverse events due to unwanted pregnancy than rural areas. An adjustment approach is required in maternal-child health-related programs in both areas, particularly for women living in urban.

Maternal health care services in Nepal: A qualitative perspective based on the socio-ecological model

Nepal has a high Maternal Mortality Rates (MMR) in the South Asian region, partly due to the poor utilization of maternal and child healthcare services. The study aims to explore the influencing factors of maternal and child healthcare services among Nepalese women. Eighteen women, who had seven-days-old-children and those recently accessed maternal and child healthcare practices, were purposively selected. The face-to-face, In-depth-Interview (IDI) was applied to collect the information. The data were thematically analyzed, where Socio-Ecological Model (SEM) was applied as a theoretical framework. The study showed that the factors such as the knowledge of women, perception, and decision-making-autonomy at individual levels influenced maternal and child healthcare-seeking behaviors. Likewise, mothers-in-law and the role of husbands at intrapersonal levels, employment at institutional levels, peers and role of neighbors at community levels, and safe motherhood program at policy levels were significant factors for the utilization of maternal and child healthcare-seeking-behaviors. The negligence of women concerning pregnancy, inadequate health facilities, lack of specialist health workers with advanced equipment, and cultural taboos and beliefs were observed as score barriers for utilization of maternal and child health-seeking behaviors. The research strongly recommends that all women be aware of maternal and child healthcare and health-seeking behaviors at their initial ages.

Evaluasi Usability Aplikasi Elektronik-Kesehatan Ibu dan Anak (e-KIA)

<p>Teknologi informasi sudah berkembang disemua bidang dan tidak terkecuali sudah diterapkan ke bidang kesehatan. Salah satu langkah awal penerapan teknologi informasi pada bidang kesehatan adalah dengan membangun aplikasi untuk memonitor kesehatan ibu dan anak yang disebut dengan <em>e</em>-KIA. Aplikasi <em>e</em>-KIA yang sudah dibangun saat ini masih belum diketahui tingkat usabilitas dari penggunaan aplikasi tersebut. Pengujian <em>usability</em> ini penting untuk dilakukan sebelum aplikasi tersebut digunakan oleh masyarakat secara luas dan dapat digunakan sebagai <em>early warning</em> untuk mendeteksi kemungkinan-kemungkinan kesalahan yang terjadi. Untuk mengatasi hal tersebut pengujian <em>usability</em> dilakukan pada aplikasi <em>e</em>-KIA. Pengujian <em>usability</em> dimulai dengan melakukan studi litearatur terkait. Kemudian dilakukan pemilihan evaluator sekaligus melakukan <em>briefing</em> proses evaluasi. Tahap selanjutnya adalah merancang instrumen untuk evaluasi dan merancang skenario evaluasi. Evaluasi <em>usability</em> yang dilakukan difokuskan pada 3 hal yaitu <em>Severity Ranking (SR)</em>, <em>Ease of Fixing Ranking</em> (EFR), dan Kategori Masalah. Masalah yang ditemukan kemudian dikategorikan berdasarkan 10 prinsip heuristik Nielsen dan disederhanakan menjadi kategori <em>Selection Driven Command</em> (perbaikan interaksi), <em>Content Organization</em> (kelengkapan konten informasi), dan <em>Visual Representation</em> (pemilihan komponen desain yang tepat). Dari hasil evaluasi tersebut didapatkan temuan masalah <em>Selection Driven Command</em> (perbaikan interaksi) sejumlah 18 temuan, <em>Content Organization</em> (kelengkapan konten informasi) sejumlah 10 temuan, dan <em>Visual Representation</em> (pemilihan komponen desain yang tepat) sejumlah 7 temuan.</p><p> </p><p><strong><em>Abstract</em></strong></p><p><em><em>Information technology has emerged in all aspect including in the healthcare field. e-KIA is an application to monitor mother and child healthcare as initial steps in implementing information technology in the healthcare field. As a newly developed application, the usability level of e-KIA is not known yet. Usability testing is important steps to be taken before the application will be used by stakeholders. Usability testing could be used to identify problems that may occur in the early stage and could be used as early warning to application aspects need to be fixed. e-KIA Usability Testing is conducted to overcome the specified problems. Usability testing started by taking the literature review followed by evaluator selection and evaluation briefing. The next step is designing an evaluation instrument and evaluation scenario. The conducted usability testing is focus on Severity Ranking (SR), Ease of Fixing Ranking (EFR), and Problem Category. The identified problems are then categorized into Nielsen’s 10 Heuristic Principal. The identified problems are simplified to three categories of Selection Driven Command, Content Organization, and Visual Representation. The experiment has found 18 problems in Selection Driven category, 10 problem in Content Organization, and 7 problems in Visual Representation category. </em></em></p>

Clinician and carer moral concerns when caring for children who tube-feed

Child healthcare can be vexed by moral concerns – this extends to the care of children who tube-feed. Children who tube-feed often receive care from family members and clinicians of various disciplines. Each brings expertise, experiences, values, and views to a situation, prioritising the child’s needs while attending to those they deem important in potentially disparate ways. Their understanding of a situation is shaped by beliefs, feelings, and perceptions. How then are key decisions made about the care of a child who tube-feeds? This article explores clinicians’ and carers’ moral concerns when caring for children who tube-feed. Interviews with clinicians ( n = 9) and carers ( n = 9) clarified three findings: first, there are often disparate beliefs about the need for tube-feeding; second, tube-feeding can evoke strong emotions; and third, it can be difficult to normalise tube-feeding. This article demonstrates how challenges can emerge when relationships between clinicians and carers diverge. Furthermore, it establishes how an ethic of care can bring different interests together to bolster the relationships required to optimise feeding care and promote health outcomes among children who tube-feed and their carers. This requires improved dialogue between and among clinicians and carers to create shared understandings of what is, what should be, and how to benefit children who tube-feed.

Implementation of Primary Healthcare Services in Community Health Stations in Highly Urbanized City

Primary healthcare is integral to the Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being. A descriptive study assessed the implementation of primary healthcare services in community health stations through a researcher-made questionnaire among healthcare providers and beneficiaries of 30 community health stations. The results revealed that, as a whole, the implementation of primary healthcare services in community health stations is great, with maternal and child healthcare implemented to a very great extent while the treatment of non-communicable diseases to a great extent only. The major challenges encountered are the lack of medical drugs, supplies and equipment, and medical professionals. Primary healthcare has made contributions to the community's health improvement; however, challenges imply that the quality and efficiency of the services need improvement. The study contributed to new knowledge on implementing healthcare at the lowest level of government, emphasizing patient-centeredness.

Maternal Exposure to Intimate Partner Violence and Child Immunisation: Insights from a Population-based Study in India

Child immunisation is regarded as one of the most essential public health interventions for reducing morbidity and mortality among children. Despite several public healthcare initiatives, a considerable proportion of children are yet to be covered under vaccination service in India. This study attempts to examine the association between maternal exposure to intimate partner violence (IPV) and childhood immunisation in India. Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. Bivariate and multivariate logistic regression models were employed to assess the associations. About 65% of sample children aged 11–23 months were fully vaccinated. After adjusting for socio-demographic factors, women’s exposure to emotional IPV was significantly associated with a lower likelihood of full immunisation (adjusted odds ratio [AOR]: 0.74, 95% confidence interval [CI]: 0.61–0.90) among children. However, physical and sexual IPV had no significant association with childhood immunisation status in the adjusted analysis. The findings suggest preventive measures against domestic violence to reduce the risk of poor child healthcare services. Furthermore, efforts should be taken for effective reproductive and child healthcare programmes, especially among socio-economically vulnerable women and children, to improve child vaccination coverage.