International Journal of Health, Medicine and Nursing Practice

Birth Plan Utilization and Associated Factors among Post Natal Women Attending Maternal Child Health Services in Moyale Sub County, Kenya

Adan Hassan — 2024-04-16

Purpose: Maternal and neonatal mortalities continue to pose big public health concern in Kenya despite several interventions. These deaths are partly attributed to three delays; delay by the mother in deciding to seek timely care, delay in arriving at the point of health service delivery and delay in receiving adequate health care once at the health facility. Birth planning is important in addressing these delays. A birth plan serves to promote positive pregnancy outcome. There is however, a paucity of data showing level of birth plan utilization and factors associated to the utilization in many areas of Kenya. This hampers efforts in promoting its utilization in reducing maternal mortality ratio. This study sought to find out extent of utilization of individual birth plan and factors that are associated with it among post-natal women attending Maternal Child Health Services in Moyale Sub County, Kenya.

Methodology: The study was a health care facility based cross sectional study that employed multi stage sampling methods. A total of 548 post-natal women attending Maternal Child health services within Moyale Sub County were interviewed. Data was collected through a structured quantitative questionnaire and FGD guide between May 2021 and July 2021 and analyzed using binomial logistic regression in SPSS version 22. To address confounding, significant variables were put through multinomial regression analysis.

Findings: Overall, 42.3% of interviewed women had used a birth plan. Socio-demographic factors associated with utilization of a birth plan was secondary level of education (OR=1.214(1.1-2.4), p=0.000), Diploma and above level of education (OR=5.7(0.5-62.1), p=0.042). Maternal factors influencing utilization of birth plan included previous complications (OR=2.6(1.3-3.0), p=0.039), four or more ANC visits (OR=2.4(1.28-3.69, p=0.000), trimester of first ANC (OR=1.4(1.3-3.7), p=0.000), PNC visits (OR=2.3(1.4-3.8), p=0.001). Health system related factors influencing utilization included time of more than one hour in reaching health care (OR=0.999(0.9-1.0), p=0.048), availability of staff at health facility (OR=3.6(1.9-3.9), p=0.024). Treating women with respect at health facility (OR=1.049(1.16-6.5), p=0.034) and availability of drugs/supplies at health facility (OR=3.3(2.2-4.5), p=0.000).

Unique Contribution to Theory, Policy and Practice: The study showed that there is need to improve quality of ANC services given in health care facilities. Health care workers in health facilities offering ANC need to initiate timely IBP counselling for pregnant mothers. There is also a need for Community health volunteers under the community health strategy to offer counselling on IBP during routine household visitations. Health care providers and patient interactions also need to improve, health workers need to be trained/sensitized on good customer relations to build patient trust. Further research is also recommended to assess quality of ANC services offered in health facilities in the region. Quality of health education and counselling offered by CHV’s during home visits to pregnant mothers also needs to be examined.

Determination of Gestational Age using Crown-Rump Length and its Associated Maternal Correlates in Igbos Living in Nnewi: An Ultrasound Study.

Chukwunwendu Aloysius Franklin Okeke — 2024-03-20

Purpose: The objective was to determine the accuracy of gestational age measured by CRL in fetuses of black women and also to identify the maternal factors affecting this accuracy in determining the gestational age by CRL measurement in fetuses of black women.

Methodology: This prospective cross-sectional study was conducted in Life and Trinity Specialist hospitals both in Nnewi, South-East, Nigeria. The gestational ages of the fetuses by CRL were determined using Siemens 2D ultrasound scan within 14 weeks and the accuracy compared with the gestational ages obtained from the Last Menstrual Period (LMP). Factors affecting the accuracy of CRL in determining the gestational age in women like the maternal heights and ages were measured. The ultrasound scan was done by a consultant in the department of Obstetrics. Analysis was done using SPSS Package version [20]. Regression analysis was used to compare dependent ad independent variables. Paired t-test was carried out on gestation period by LMP and gestation period by CRL to know if the mean difference between the gestation period by LMP and gestation period by CRL is significant. Multiple correlation analysis was used to ascertain the degree of relationship between maternal weight and age and gestational age by LMP and CRL.

Findings: The result showed that two hundred and sixty-five women met the inclusion criteria but two were lost to follow up and two hundred and sixty-three were used finally for analysis. The accuracy of ultrasound scan in estimating the gestational age using CRL is within one week in majority of the cases. Maternal height, weight and age are poorly correlated to age of the fetus using the CRL. The fetuses of black women showed a marginal increase in length at gestational age below eight weeks but afterwards this difference is not pronounced. In conclusion, the accuracy of CRL in determining the gestational age is within one week in majority of cases. The maternal height and age are poorly correlated to the CRL of the fetus and thus to the gestational age.

Unique Contributor to Theory, Policy and Practice: Ultrasound scan incorporated with growth chart for fetuses of white women can be equally used to ascertain the gestational ages of fetuses of black women with insignificant difference

APOL 1 Risk Genotype is associated with Albuminuria in Sub-Saharan African without Hypertension: A Case Study of Trypanosoma Brucei Gambiense Endemic Area

Dominique M. Mupepe — 2024-03-11

Purpose. An association between APOL1 risk genotypes (HRG) and hypertension has been reported in African Americans with chronic kidney diseases (CKD). However, such data from African populations living in a Human African Trypanosomiasis (HAT) endemic area remain limited.This study assessed the association between APOL1 high-risk genotypes (HRG) and hypertension among sub-Saharan African in T.b. gambiense endemic area.

Methodology. This cross-sectional study enrolled 94 HAT-infected and 144 non–infected participants in Masimanimba, the Democratic Republic of the Congo, from April 2019 to April 2021. We evaluated the association between APOL1 HRG and hypertension in HAT-infected and non–infected participants. APOL1 HRG was defined as the presence of two risk variants (G1/G1, G2/G2, or G1/G2), and a low-risk genotype (LRG) with the presence of 0 or 1 single variant. The elevated albuminuria was defined as urinary albumin/creatinine ratio ≥ 30 mg/g. Student’s and Pearson's Chi² tests or Fisher’s exact test were used to compare means and proportions. The Wilcoxon/Mann–Whitney test was used to compare medians. A multivariate logistic regression model was used to identify independent determinants of hypertension. Odds ratios were provided with their 95% confidence intervals (Cis). Statistical significance was set at p < 0.05, based on 2-tailed test.

Findings. APOL1 sequence analysis revealed that 3 of 21 (14.3%) hypertensive participants carried HRG (G1G1) and 7 of 103 (6.8%) non-hypertensive carried HRG (G1G1, G2G2, and G1G2) (p=0.371). The frequency of APOL1 HRG among hypertensive participants was 14.3% in both HAT- infected and uninfected individuals. Ten of 21 (47.6%) hypertensive individuals with elevated albuminuria had a higher incidence of CKD (100% vs. 0%; p < 0.001) and HRG (30% vs. 0%; p = 0.09) than 11 (52.3%) without albuminuria who carried LRG. Of 103 non-hypertensive subjects, 43 (41.7%) with elevated albuminuria had a higher frequency of HRG (16.3% vs. 0%; p = 0.002) and CKD (100% vs. 1.7%; p<0.001) compared with 60 of 103 (58.3%) without albuminuria who carried LRG.

Unique contributor to theory, policy and practice: APOL1 HRG was associated with albuminuria and CKD, regardless of the hypertension status in T.b. gambiense HAT endemic area. However, further prospective cohort studies are required to confirm these results. The High-risk subjects will benefit from early preventive measures in low-income countries.

Bridging Healthcare Horizons: Illuminating Pakistani Medical Students' Perspectives on Telemedicine

Sadaf Said — 2024-04-07

Purpose: In the evolving landscape of global healthcare, telemedicine stands out as a beacon of progress, offering enhanced accessibility. Nowhere is its impact more critical than in the rural expanse of Pakistan, where traditional healthcare struggles to reach. This research delves into the minds of Pakistani medical students, a cohort pivotal in steering the future of healthcare delivery in the country.

Methodology: The research design for your study can be described as cross-sectional or survey research, focusing on understanding the telemedicine exposure, interest levels, and plans for future utilization among Pakistani medical students across 20 medical schools.

Target Population: The target population in your study comprises Pakistani medical students enrolled in the 20 medical schools included in the study.

Findings: Among the 396 students surveyed, 24% boasted prior exposure to telemedicine, while a noteworthy 52% expressed unwavering intentions to incorporate it into their future medical practices. Notably, 73.8% of those with prior exposure were resolute in their commitment to using telemedicine, compared to 43% without prior exposure. Among the undecided students, 21% had been exposed previously, shedding light on the profound influence of exposure on shaping future intentions.

Unique Contribution to Theory, Policy, and Practice: This research goes beyond the surface exploration of medical students' attitudes towards telemedicine; it makes a distinctive contribution to theoretical frameworks, policy development, and practical implications. The study acts as a theoretical cornerstone by shedding light on the intricacies of the awareness gap within this demographic. From a policy perspective, the findings provide policymakers in Pakistan with a nuanced understanding of the current state and future potential of telemedicine integration into the healthcare system. The practical implications are profound, emphasizing the urgent need for early education in telemedicine to prepare the next generation of healthcare professionals for the challenges and opportunities presented by an evolving healthcare landscape.

Exploring Antibiotic Self Medication Patterns: A Cross-Sectional Study among Patients in Multiple Hospitals

Aswad Shahid — 2024-03-14

Purpose: The purpose of this study is to explore the multifaceted impact of self-medication with antibiotics, delving into its implications for public health. The potential repercussions of self-medication extend beyond individual well-being. This study investigates the broader consequences, including the wastage of crucial healthcare resources, the development of antibiotic resistance, adverse reactions, delays in seeking appropriate medical care, and the exacerbation of common illnesses. By understanding the complexities surrounding self-medication, particularly with antibiotics, we aim to contribute valuable insights to inform public health strategies, medical interventions, and educational campaigns.

The research seeks to identify patterns, motivations, and behaviors associated with self-medication, shedding light on the factors that drive individuals to bypass professional medical advice. With a focus on antibiotics, a class of drugs critical for treating bacterial infections, the study aims to highlight the potential risks and challenges posed by unsupervised antibiotic use.

Methodology: This cross-sectional study, conducted from September 13 to September 25, 2022, investigates self-medication with antibiotics among 300 patients from five hospitals. Employing a confidential 20-question questionnaire administered through face-to-face interviews, the research aims to understand prevalence and patterns of self-medication. Quantitative data analysis utilizes parametric Z-tests through SPSS Software (version 21). Ethical considerations include obtaining approval, ensuring informed consent, and maintaining confidentiality. Limitations include potential selection and recall bias associated with convenience sampling and self-reported data, respectively.

Findings: Among the 300 participants, 47% were male, and 53% were female. The majority were adults aged between 20 to 40 years, with 64% from Rawalpindi. Over 50% of participants had matriculation or higher education. Ninety-seven percent of people had used antibiotics at least once in their life, with 63% practicing self-medication. Notably, 49% self-medicated 1-5 times in the past year. The primary reasons for self-medication included convenience (47%), personal experience (34%), and previous doctor's prescriptions (32%). Only 36% completed the prescribed antibiotic course. A significant percentage (71%) never changed the dosage of antibiotics, while 22% sometimes altered the dosage. Switching antibiotics during the course occurred in 21% of cases, primarily because the initial treatment was ineffective. Additionally, 51% of participants believed they could successfully treat common infections with antibiotics. Most participants (63%) stopped taking antibiotics if they experienced side effects during the course. A majority (62%) did not complete the antibiotic course after early symptom relief. Regarding dosage, 74% of participants believed that larger antibiotic doses did not guarantee quicker action. Furthermore, 36% of participants occasionally gave prescribed antibiotics to sick family members, and 10% always did.

Unique Contribution to Theory, Policy and Practice: This research significantly advances our understanding of antibiotic self-medication across theoretical, policy, and practical dimensions. The study intricately explores the prevalence and nuanced patterns characterizing patients' self-medication behaviors with antibiotics, thereby contributing to the refinement of existing theoretical frameworks in healthcare behavior. The comprehensive insights gained from this research provide a foundation for a more sophisticated understanding of the intricate interplay of factors influencing patients' decisions regarding antibiotic use. This understanding enables the formulation of targeted policies aimed at mitigating the potential risks associated with unsupervised antibiotic use, contributing to broader public health initiatives combating antibiotic resistance and ensuring the well-being of communities.