BackgroundIn Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.ResultsUtilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.ConclusionThe integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.
BackgroundIntegrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas.AimThis process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up.Design & settingThe mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities.MethodThe care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsThe intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months.ConclusionIntegrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.
BackgroundIn Pakistan about 18% of all adults are affected by hypertension, and only one in eight of the prevalent cases have their hypertension controlled. As in many other low-middle income countries, a public–private partnership approach is being considered for delivering non-communicable disease care in urban areas.AimThis process evaluation was undertaken to understand how an integrated care intervention was experienced by the care providers and patients, and to inform modifications before possible scaling.Design & settingThe mixed-methods study was conducted as part of a cluster randomised trial on integrated hypertension care at 26 private clinics.MethodThe care practices were assessed by analysing the clinical records of 1138 registered patients with hypertension. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsDistrict-led objective selection and context-sensitive staff training helped to get the clinics engaged in partnership working. About one-third of patients with hypertension had associated diabetes or renal compromise. The prescription of drugs is influenced by multiple non-clinical considerations of providers and patients. Many doctors allowed the use of home-based remedies as supplements to the prescribed allopathic drugs. Female patients faced more challenges in managing lifestyle changes. The intervention improved adherence to follow-up visits, but patient attrition remained a challenge.ConclusionThe integrated hypertension care intervention at private clinics is feasible, and leads to improved diagnosis and treatment in low-income country urban setting. The authors recommend continued implementation research and informed scaling of hypertension care at private clinics.
Background: Bacterial Vaginosis (BV) is one the most common causes of vaginal discharges that occur in women of reproductive age. This cross sectional study was focused on the prevalence of BV in patients presenting to DHQ hospital, Lower Dir, KP. Objectives: To determine the prevalence of bacterial vaginosis. Study was conducted at DHQ hospital Timergara, Dir Lower, KP Pakistan after taking approval from hospital. Materials and methods: This cross sectional study was conducted at DHQ hospital Timergara, Dir Lower, KP after taking approval from hospital’s ethical committee. Patients from 18 to 45 years were included (only married patients). Written consent was taken from the patients. Patients having bacterial vaginosis were enrolled in the study. Results: A total of 384 patients of reproductive age group with symptoms of bacterial vaginosis presented to DHQ Hospital Timergara from April 2020 till September 2020. The results showed that higher number of bacterial vaginosis was detected in age group of 21 to 30 years that is 61 (32.4%) while the lowest number was 31 (16.5%) which was detected in 18-20 years’ age group. Bacterial vaginosis was found to be statistically insignificant with age groups keeping P < 0.05). Conclusion: It was concluded that Bacterial Vaginosis is common cause of vaginal discharge. Proper hygiene should be maintained. Medical professional such as gynecologists should help the patients understand the dangers of BV and how to avoid it through proper counselling. Recommendation: The overall prevalence according to this study was 49%, the mean age of the patients was 30.76±8.75 while the highest prevalence was found in the age group of 21 to 30 years. Proper counselling by the gynecologists regarding hygiene is needed to control bacterial vaginosis.
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