Leadership Styles and Employees’ Commitment among Government Hospitals in Dodoma City, Tanzania

This study aimed to explore leadership style and employee commitment among government hospitals in Dodoma City using the cross-sectional research design. The sample of 120 out of 889 employees was determined through simple random sampling procedure but only 102 returned the questionnaires. The following leadership styles were found to be existing: status quo, people oriented, democratic, task oriented and autocratic. Affective commitment, continuance commitment and normative commitment existed in the organizations under investigation. There is a significant positive correlation between commitment of employees and two styles of leadership: democratic leadership accounting for 24.1% and autocratic leadership, accounting for 5.6%. There is no significant relationship between employees’ commitment and the following leadership styles: task oriented, people oriented, status oriented and laissez faire. The study recommends that employees need to be appraised for their commitment to the organizations. This can be done through various types of motivation in order to maintain their commitment spirit. The leaders of the organizations should be encouraged to increase the use of democratic and autocratic leadership styles which have accounted for employees’ commitment.

AN OBSERVATIONAL STUDY OF CESAREAN TRENDS AT A TEACHING HOSPITAL IN PUNJAB

Objectives: The objective of the study was to study the indications and risk factors for caesarean section (CS) and to study the caesarean rates in various patient groups as per Robson’s classification. Methods: This prospective observational study was conducted at Government Medical College Amritsar over a period of six months. All the patients admitted for delivery beyond 22 weeks were allotted to Robson groups on admission and the indications of all CS were recorded. The data collected were tabulated and analyzed statistically. Results: There were 553 deliveries in the study period, of which there were 241 CS amounting to a caesarean rate of 43.6%. Nulliparity, previous caesarean delivery and malpresentation were significant risk factors for CS but induction of labor was not associated with increased probability of caesarean delivery. Previous caesarean delivery was the most common indication of CS followed by foetal distress. Among Robson groups, group 10 had the biggest group size and biggest contribution to cesarean rates followed by group 5. Conclusion: Tertiary care government hospitals have a higher cesarean rates due to referral of high-risk pregnancies. Increasing the rates of trial of labour after caesarean is one of the interventions that may serve to decrease the caesarean rates in such institutions.

DIETARYPRACTICES OF DIABETES MELLITUSPATIENTS TYPE 2 IN RELATION WITH DEMOGRAPHIC VARIABLES AT PRIVATE AND GOVERNMENT HOSPITALS IN SANAA CITY, YEMEN, 2018

Background: Diabetes mellitus is one of the most common chronic diseases in nearly all countries. The most common type is type 2 diabetes.Dietarypractices of diabetes mellitus patients type 2 in relation with demographic variables at private and government hospitals in Sanaa city, Yemen the objective of present study. A hospital-based cross - sectional descriptive study conducted from October 2018 to May 2019, among adultsfrom both gender attended to the selected hospital in Sanaa to receive health service. A prepared questionnaire was used for data collection. Data analyzed by using SPSS softwareversion 20 was used. Descriptive statistics were performed to describe the socio-demographic and dietary practices variables. Data described by frequencies and percentages and presented in tables. Chi square test was used to test differences in dietary practicesin relation with demographic variables. Test considered to be significant p value < 0.05. The sample was formed of 200 adult diabetic patients, more than half (53.5%) were females. Ages of participant ranged between 25 years and 80 years, with a mean of 52 ± 11 years. Illiterate women represented 62% of total women, while illiterate men represented 13% of total men. Nearly half of participants had poor dietary practices (45.5%) towards diabetes.There was a better score of good & acceptable dietary practices tend to be more in private hospitals.There is a need to strengthen good dietary practices through health education.

Patients' Evaluation of the Quality of Emergency Care Services in Jordan: Integration of Patient Centeredness Model

Background and PurposeAccreditation is viewed to enhance the total quality of healthcare. The present study aims at assessing patients' perspectives toward the quality of emergency healthcare services at different hospitals with different characteristics in Jordan. The elements of patients' perception were aligned with the conceptual framework of Patient Centeredness Model.MethodsThis descriptive cross-sectional study was carried out in four emergency departments from different healthcare sectors and accreditation statuses in Jordan. Less urgent/nonurgent, alert, and cooperative patients were identified directly after the completion of emergency treatment. The perspectives of patients about the quality of emergency services were evaluated by 10 domains articulated in a validated accident and emergency questionnaire.ResultsA total of 276 patients were enrolled in the study. Private sector scored higher in all assessment domains in both accredited and nonaccredited hospitals in comparison with the government sector. Accredited government hospitals scored higher in patients' evaluation for “doctor and nurse,” “investigations,” “pain,” and “overall respect of medical staff” domains than nonaccredited government hospitals. The overall experience was significantly different between accredited and nonaccredited government hospitals.Implications for PracticeQuality of emergency care services should be assessed through various dimensions related to patients' perspectives. Patients' perception toward the quality of emergency health services is evidently enhanced by accreditation especially in the government sector.

Determinants of women’s preferred and actual abortion provision locations in Nigeria

Background Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women’s decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted. Methods This analysis uses data from a 2019–2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women’s preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women’s decisions about where to terminate their pregnancy and identify factors hindering women’s ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location. Results Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). “Privacy/confidentiality” was the most common main reason driving women’s abortion provider/location choice (20.7%), followed by “convenience” (16.9%) and “recommended” by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence. Conclusions These findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women’s choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women’s abortion care preferences in a legally restrictive environment.

Health Problems & Barriers to Healthcare Services for the Transgender Community in Lahore, Pakistan

Objectives: To find out the major health problems and barriers in getting health care by transgender community in Lahore, Pakistan. Methods: An analytical cross-sectional study was conducted in transgender community of Lahore from January to October 2020. The study included 214 participants from different areas of Lahore by targeting their “gurus”. Non-probability, snow-ball sampling technique was used to collect required sample size. Data was collected by using a structured questionnaire. Data were analyzed using SPSS version 23. Results were generated in form of tables and graphs. Chi square test and Fischer’s exact test were used to find out associations between health seeking behavior with their transgender status and p value was fixed as ≤ 0.05 as significant. Results: Among total 214, 78.5% were transgender females and 21.5% were transgender male. Among the common health problems were depression (56%), anxiety (59%) and genital tract ulcers (45%). About 70% transgender seek health care from government hospitals. Among total 214 participants, 70% reported that they receive poor quality of health care. The main reasons of not getting proper care is non acceptance (20.7%), feeling ashamed (28.7%), non-availability of CNIC (44.5%) and un-affordability (6.1%). Significant association of transgender female with consultation with doctors (p=0.013), seeking care at government hospitals (p =0.038) poor experience at health care facility (0.050), neglect during medical treatment (p=0.015) and feeling of discrimination during treatment (p= 0.042). Conclusion: Transgender community face physical, mental, social and reproductive health issues. About 70% trans-genders receive poor quality of health care services. Non acceptance, feeling ashamed, non-availability of CNIC and non-affordability have been reported as major barriers in getting desired health care. doi: https://doi.org/10.12669/pjms.38.1.4375 How to cite this:Manzoor I, Khan ZH, Tariq R, Shahzad R. Health Problems & Barriers to Healthcare Services for the Transgender Community in Lahore, Pakistan. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4375 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Breakdown Time Analysis in The Effort to Maximize Medical Equipment Productivity in Hospital

Health equipment in hospitals determines the productivity of health service delivery. Medical equipment must continue to function properly. One way to measure the success of maintaining medical devices is by standard Breakdown Time. This study aims to determine the application of standard Breakdown Time on damaged medical devices. The research method used is a descriptive qualitative method with in-depth interviews. There are interviewees with private status and ASN (government employees). From the private sector, there are consultants, technical managers, and administrators of professional organizations in the field of medical equipment. Interviewees with ASN status are practitioners of maintenance and repair of health equipment in government hospitals. The results of the interviews were compiled into 6 groups based on the main questions asked, then analyses descriptively. The results of the study, Standard Breakdown Time have not been applied comprehensively in hospitals. Several informants informed that although there is an application of breakdown time, the standard is not yet clear and is only applied to high-tech equipment and/or for a minimal number of equipment there is only one in the hospital. For other equipment, there is no standard when the damage occurs, until when the damaged equipment must be able to function again. In conclusion, the Standard Breakdown Time for medical devices is important and its application must be supported by Ministerial-level regulations.

An Application for Measuring and Analyzing the Level of Performance Accuracy for Health Services Quality Indicators by Using Six-Sigma: A Study Case of Government Hospitals in Khartoum State

The study aimed at acknowledging the Six Sigma methodology and the existence of the essential components for the application, as well as reducing the time for completing the operations, reducing the error rate to the lowest possible level, and improving the quality of operations. For this objective, the analytical descriptive methodology was used on a sample consisted of 300 administrative and medical staff from Khartoum State Hospitals (Khartoum, Omdurman, Bahri). To this end, a questionnaire was used for collecting data and for analyzing it and achieving the results of the study by using the statistical analysis package (SPSS). The study deduced a number of results, the most important of which are that the items of commitment and supreme command support for the senior leadership and the methods of abundant human resources on quality control, and the application of the Six Sigma methodology in government hospitals in Khartoum state achieved a satisfactory level, while continuous improvement paragraphs, processes, and systems on quality control and the application of Six Sigma methodology achieved high quality. There is a significant effect on the extent of commitment and support of the higher leadership on quality control and the application of the Six Sigma methodology. Similarly, there is a statistically significant effect on the application of continuous improvement methods on quality control and Six Sigma methodology. Also, there is a statistically significant effect on the application of the abundance of human resources methods variable on quality control and the application of Six Sigma methodology in governmental hospitals in Khartoum state. The study recommended to take interest in the Six Sigma methodology and assure the possibility of using it in Khartoum State’s hospitals because of its scientific and practical importance in improving the quality of services and provided processes, and the need to provide qualified financial and human resources for using and developing Six Sigma methodology in hospitals, as well as great attention in training and providing departments heads with full knowledge of Six Sigma methodology and the fundamentals on which Six Sigma methodology, is based on its importance for hospitals. The study also recommended associating the promotions system in government hospitals in Khartoum state with the quality control program.