Starting at the community: Treatment seeking pathways of children with suspected severe malaria in Uganda

IntroductionCommunity health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria.MethodsAn observational study in Uganda enrolled children below five years presenting to CHWs with signs of severe malaria. Children were followed up 28 days after enrolment to assess their condition and treatment-seeking history, including referral advice and provision of antimalarial treatment from visited providers.ResultsOf 2211 children included in the analysis, 96% visited a second provider after attending a CHW. The majority of CHWs recommended caregivers to take their child to a designated RHF (65%); however, only 59% followed this recommendation. Many children were brought to a private clinic (33%), even though CHWs rarely recommended this type of provider (3%). Children who were brought to a private clinic were more likely to receive an injection than children brought to a RHF (78% vs 51%, p<0.001) and more likely to receive the second or third-line injectable antimalarial (artemether: 22% vs. 2%, p<0.001, quinine: 12% vs. 3%, p<0.001). Children who only went to non-RHF providers were less likely to receive an artemisinin-based combination therapy (ACT) than children who attended a RHF (odds ratio [OR] = 0.64, 95% CI 0.51–0.79, p<0.001). Children who did not go to any provider after seeing a CHW were the least likely to receive an ACT (OR = 0.21, 95% CI 0.14–0.34, p<0.001).ConclusionsHealth policies should recognise local treatment-seeking practices and ensure adequate quality of care at the various public and private sector providers where caregivers of children with suspected severe malaria actually seek care.

Determination of Level of Serum Iron among Routine Iron Supplemented Pregnant Women Attending Private Clinic in Sulaimani City, Kurdistan-Iraq

Iron deficiency, with or without anemia, is common in pregnant women and more than half of the anemia’s in the world are due to the deficiency of iron in the serum. The aims of this study were to determine the percentage and level of serum iron among iron supplemented pregnant women in different trimesters and in different age groups among supplemented pregnant women in Sulaimani city. This study was carried out in the private clinic in the Sulaimani city-Kurdistan Region of Iraq. The pregnant women were participated and enrolled between the first of December 2018 and first of December 2019. Two hundred and seventy-five healthy and iron supplemented pregnant women were selected randomly and the questionnaire form, which contains information about age of mothers and their gestational age, was filled and serum iron level was measured by COBAS C111 analyzer. The results of this study found that the percentage of iron deficiency among participants was high 33%, 45%, and 52.6 % in the first trimester in different age groups <25, 25–35, and above 35 years old, respectively. However, in the third trimesters decreased to 12.5%, 7.1%, and 3.7% in <25, 25–35, and above 35 years old, respectively. Regarding serum iron levels, the present study found that there were significant differences between ages 25 and 35 with age <25 years. However, there was no significant difference between first, second, and third trimesters. This study concludes that the percentage of iron deficiency among supplemented pregnant women was high compared to other cities or other countries. Pregnant women who their ages <25 are at risk of serum iron deficiency. On the other hand, pregnancy trimesters had no effects on the serum iron level among supplemented pregnant women.

Patient Satisfaction with Private Recovery Services and Importance of Physician Behavior during COVID Time

Introduction: Patient satisfaction represents an essential indicator of the quality of care in the medical recuperation sector. This study aimed to identify the degree of satisfaction in patients who benefit from medical recuperation services in one private clinic from Romania and the factors that played a part in this respect. Method: An online questionnaire was completed by 105 patients of a private clinic in the period immediately following the opening of the clinic after the quarantine period due to COVID-19. The following concepts were measured: general satisfaction with clinical recuperation services (SG), physician’s behavior (PB), the impact of interventions on the state of health (IHI), modern equipment (ME), and the intention to return to the clinic (IRC). Based on a linear regression model, the impact of PB, IHI, ME, and IRC variables on general satisfaction (SG) was established. Results: The study results confirm the data from studies carried out in different sociocultural contexts in ordinary time, where physician behavior is the most crucial factor in patients’ satisfaction. Therefore, we can say that the physiotherapist’s behavior has an essential role in determining the patients’ satisfaction both in ordinary time and in COVID-19 time. The data in this study reflect the fact that satisfaction with the services offered by a medical recuperation clinic is a predictor for using the services in the future. Still, our study reflects a moderate relationship in intensity.

Pediatric Cutaneous Leishmaniasis in a Private Clinic of Abidjan, Ivory Coast: A Case Report

Introduction: Cutaneous Leishmaniasis (CL) is a zoonotic disease with global distribution, especially in underdeveloped countries. This parasitic disease is caused by the bite of an infected sandfly. Case Report: We report here the first case of cutaneous leishmaniasis discovered incidentally in an 11-year-old child in a private clinic. He is a primarian boy who had a wound located on his left leg. On questioning, we ascertained that the wound was not the first one and had been present for about 2 months. The cutaneous lesion was painless but itchy. The location, the crateriform appearance, and the chronic nature of the wound led us to suspect a case of cutaneous leishmaniasis. Methods: Microscopic examination of cutaneous exsudation’s smears of lesions revealed amastigote forms of leishmania, confirming our diagnostic hypothesis. The child was placed under Imidazole-based treatment associate cloxacilline. The child also received local gentamycin-based dressings. Results: The child was cured after one month. The diagnostic issues of cutaneous leishmaniasis constitute a great challenge for practitioners in endemic zone. Also, a systematic differential diagnostic should be required in the face of chronic wounds. Conclusion: The integration of the screening and management of cutaneous leishmaniasis against Buruli ulcer are eagerly waited as a future work.

Treatment adherence and related factors among patients in the unique MMT private clinic in Vietnam in 2018

A cross-sectional study using the take-all sampling method was conducted among patients in the unique MMT private clinic in Vietnam in 2018. The study aimed to describe treatment adherence status and related factors of the patients. Data on socioeconomic characteristics, behaviours, treatment process, level of social/family support were collected and analyzed. The results showed that 88.2% of MMT patients completely adhere to the treatment program. Factors positively related to treatment adherence of MMT patients were living with spouse/partner (OR = 3.02 95% CI: 1.11 – 8.19), not using illicit drugs during MMT treatment (OR = 5.88; 95% CI: 1.77 – 19.56). The methadone clinic should pay attention to the factors positively related to treatment adherence in the counselling and support process for the patients.

Professional Teeth Scaling by Dentists and Dental Therapists During COVID-19 Pandemic

The recent advent of the COVID-19 pandemic has caused widespread public health concerns and affected provision of health care including the delivery of professional teeth scaling by dental professionals. A cross-sectional online survey of dentists and dental therapists in Rivers State, Nigeria. Questionnaires were distributed to consenting participants using SurveyMonkey. Data were collected on sociodemographic, practice of scaling, and knowledge of recommended guidelines by WHO/CDC on the use of preoperative mouth rinses and Personal Protective Equipment (PPE). Data analysis was done and level of significance was set at p-value < 0.05. Sixty-three dentists and 34 dental therapists participated in this study with a mean age of 35.71±8.58 years. About two-third of the respondents did not perform teeth scaling for their patients during the early pandemic period. Fifty percent of dental professionals in government owned dental clinics performed teeth scaling while none of the private clinic staff did the procedure. The major reason for not performing the procedure was non provision of PPEs followed by fear of contacting the virus. Most (84.1%) of the dentists and 47.1% of dental therapists demonstrated a good knowledge of the recommended guidelines. Almost all (94.7%) of the private clinic staffs demonstrated a good knowledge compared to 65.4% of dental professionals in the government owned clinics. More than half of the dentists and only a few dental therapists performed scaling for their patients during the early period of the pandemic. Dentists and private clinic staffs demonstrated a good knowledge of the recommended guidelines for treatment.