Open Access Review Article

Essentials of Healthcare Marketing

Marium Syed, Farah Ahmed, Nisha Zahid, Nimra Khalid, Noor Israr

Asian Journal of Medicine and Health, Page 73-79
DOI: 10.9734/ajmah/2021/v19i230306

This is a systemic review to identify the essentials of health care marketing. The objective of this study is to critically analyze, assess, and document the literature [1,2,3] (Balogun and Ogunnaike, 2017; Awaand Eze, 2013) on elements of health care marketing, to establish its scope and to identify its gaps in various studies literature and to make further recommendations related to this field. Practitioners and researchers are slowly and gradually recognizing and identifying the importance of health care marketing for the growth of this industry. However, all have not yet embraced the methodical application of marketing theories. The data, which is available on diversity of service providers, different care services that are available and their comparative and respective impact on health care marketing have limitations.

Open Access Original Research Article

Diagnostic Accuracy of Ziehl-Neelsen Smear Microscopy in Comparison with GeneXpert in Pulmonary Tuberculosis: A Multi-Center Study in Kandahar Province, Afghanistan

Mujeeb Ahmad, Muhammad Haroon Stanikzai, Najeeb Rahimy, Abdul Wahed Wasiq, Hadia Sayam

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/ajmah/2021/v19i230299

Background: Tuberculosis (TB) is a major global health problem. The early and accurate diagnosis is crucial for disease management and to control disease transmission and the emergence of drug resistance TB.

Objectives: This study was carried out to determine the diagnostic accuracy of Ziehl Neelsen (ZN) smear microscopy in comparison with GeneXpert MTB/RIF in pulmonary tuberculosis in Kandahar province, Afghanistan.

Methods: This was a facility-based cross-sectional study. We scrutinized TB registers of three health facilities to include patients who had their sputum tested by both ZN smear microscopy and GeneXpert MTB/RIF. We extracted 734 patients’ data registered during January 2019 - June 2020 in a structured form. Kappa value was analyzed using SPSS version 19 software at 95% Confidence Interval (CI). We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of ZN smear microscopy against GeneXpert MTB/RIF.

Results: In comparison with GeneXpert as a reference test, ZN smear microscopy has 67.7% (95% CI:63.44%-70.74%) sensitivity and 100% (95% CI:98.74%-100.00%) specificity. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 99.89% (95% CI:99.88%-99.90%), respectively. The agreement between ZN smear microscopy and GeneXpert MTB/RIF results was moderate (70.4%) and the Kappa value was 0.45 (95% CI:0.38-0.59).

Conclusion: This study has found high specificity but moderate sensitivity for the diagnosis of pulmonary TB using sputum ZN smear microscopy test. Hence, GeneXpert MTB/RIF test is more accurate and reliable for the diagnosis of pulmonary TB.

Open Access Original Research Article

Early Treatment with Hydroxychloroquine Improves Clinical Outcomes and Reduces Hospital Admissions in COVID-19 Associated Pneumonia

A. D’Alessio, M. Cottini, C. Lombardi, M. Uccelli, F. Bracchi, G. Cesana, D. Di Mauro, A. Fargnoli, C. Giussani, F. Martini, M. Motta, S. Olmi, N. Sertori, M. Taverna, P. Del Poggio

Asian Journal of Medicine and Health, Page 15-26
DOI: 10.9734/ajmah/2021/v19i230301

Background: Hydroxychloroquine (HCQ) has been used against SARS-CoV-2, but large non randomized studies failed to show any clinical benefit. However, in these studies the drug was started in the hospital setting, a significant time after the onset of symptoms.

Aim of the Study: to verify if HCQ, given early after the onset of symptoms and in the outpatient setting, can reduce hospital admissions and improve clinical outcomes of COVID-19

Methods: We performed a retrospective study on 824 patients with COVID-19 pneumonia in the Bergamo province (Lombardy, Italy). Patients were divided in 2 cohorts: the first included 354 outpatients attended by Primary Care Physicians (PCP), the second included 470 patients admitted to an Emergency Department (ED) during the same period. We compared rate of hospital admission and clinical outcomes in patients treated with HCQ within 6 days from the onset of symptoms, with all other patients. Clinical outcomes were evaluated at a 1-month time-point.

Results: Patients who received early treatment with HCQ showed a lower rate of hospital admissions (p<0.0001), mechanical ventilation (p<0.0022) and need for oxygen supplementation at home (p=0.002) in the first cohort and improved survival in the second (p=0.03). Early treatment with HCQ was the only independent variable influencing all predefined outcomes on multivariate analysis.

Conclusions: Treatment with HCQ, initiated within 6 days from the onset of COVID-19 may improve both clinical outcome and rate of hospital admissions.

Open Access Original Research Article

Physicians’ Attitude towards Patients’ Spirituality at a Tertiary-Care Health Facility in Southern Nigeria

G. K. Eke, N. Onodingene

Asian Journal of Medicine and Health, Page 27-35
DOI: 10.9734/ajmah/2021/v19i230302

Background: It has been shown that patients would like to discuss their spiritual beliefs with their physicians and that they have spiritual needs which are often under addressed by health care professionals. Whereas, addressing those needs in clinical practice is a component of the holistic care that every patient deserves, the attitude of physicians towards addressing them has not been ascertained in our environment.

Objectives: To explore physicians' attitude and self-reported behavior towards patients’ spirituality in clinical practice at a tertiary health facility in Southern Nigeria.

Methods: In this cross-sectional survey carried out between August and November 2020, a semi-structured and self-administered questionnaire was completed by the participating physicians which were of various ranks and working in various departments of the hospital. Their attitude towards their patients’ spirituality in clinical practice and self-reported behavior were analyzed using SPSS version 25.0.

Results: A total of 200 physicians participated in the study, 90% of them were residents of various cadres, two-third (n=122; 61%) had less than 10 years work experience. Majority of respondents (n=163; 81.5%) considered it appropriate to make inquiries about their patients’ spirituality and less than half of them (n=98; 49%) were aware that there is a religious leader in the hospital who offers pastoral care. Half of the respondents (n=104; 52%) reported they rarely take spirituality history of patients, 18 (9%) often pray with the patient while 100 (50%) rarely refer patients for pastoral care. Insufficient time was the most frequent barrier to discussing spiritual issues with patients. However, only 5 (2.5%) respondents were able to name 3 common tools a health worker can use to assess patients’ spiritual needs.

Conclusion: Physicians enquiry into patients’ spirituality was inconsistent, and there were gaps between their attitudes to discussing these issues with their patients and its practice. Incorporating spiritual care courses into physicians’ training is recommended to overcome the barriers to both patient and physician spiritual inquiry.

Open Access Original Research Article

Availability and Utilization of Personal Protective Equipment by Nigerian Physiotherapists during COVID-19 Pandemic

Uchenna Prosper Okonkwo, Joseph Onuwa Umunnah, Ebere Yvonne Ihegihu, Fatai Adesina Maruf, Emmanuel Chiebuka Okoye, Chukwuebuka Olisaemeka Okeke, Chisom Godswill Chigbo

Asian Journal of Medicine and Health, Page 36-53
DOI: 10.9734/ajmah/2021/v19i230304

Introduction: Physiotherapists are exposed to contracting infectious diseases because of the level of contact they have with patients in the course of performing their statutory clinical duties.

Objective: The major objective of the study is to determine the availability and utilization of personal protective equipment (PPE) by Nigerian physiotherapists during the COVID-19 pandemic.

Methods: One hundred and eighty-one (181) Nigerian physiotherapists participated in an online survey using Google Form application that lasted between September 2020 and October 2020. The data collection instrument was a 22-item close-ended online questionnaire with three domains:  demographics, availability of PPE, and utilization of PPE. The authors made use of different WhatsApp platforms hosting only physiotherapists as a means of reaching out to the respondents. Data obtained from the study were analyzed using STATA 13. A p-value of less than 0.05 was considered to be statistically significant (confidence level = 95).

Results: The result of the study shows there were high availability and utilization of facemasks and hand gloves for the Nigerian physiotherapists during the period of COVID-19 pandemic in the different health facilities; it also shows there was low availability of apron and poor availability of protective eye shield/goggles and shoes during the same period. The finding also showed there was low utilization of apron, protective glasses and shoes by the Nigerian physiotherapists during the peak of COVID-pandemic.

Conclusions: Most Nigerian physiotherapists had more face masks and hand gloves during COVID-19 pandemic than they had protective aprons, goggles and shoes. Also, there was high utilization of facemasks and the hand gloves more than an apron, eye shield and protective shoes because the more the PPE was available the more the utilization by the Nigerian Physiotherapists.

Open Access Original Research Article

Mortality in Systemic Lupus Erythematous in Milton Cato Memorial Hospital Saint Vincent and the Grenadines; A 5-year Retrospective Study

Adedeji Okikiade, Ikeokwu Anderson, Twanna Browne-Caesar, Olayinka Afolayan-Oloye, Ugwu David

Asian Journal of Medicine and Health, Page 54-72
DOI: 10.9734/ajmah/2021/v19i230305

Background: Systemic Lupus Erythematous (SLE) is a rare, severe and lasting autoimmune disease that can vary in severity from mild to possibly life-threatening with a multi-system manifestation characterized by symptoms relating to joint, skin or mucosal inflammation, or with a varying degree of haematological abnormality or constitutional features, with women affected predominantly with peak onset (15-44) years of age.

Aim: This study was aimed at estimating the incidence and mortality of Systemic Lupus Erythematous lupus in Milton Cato Memorial Hospital Saint Vincent and the Grenadines, including temporal trends and variations in age and sex from 2014 to 2018 by using routinely collected administrative health data/patient records.

Methods: From 2014 to 2018, individuals with SLE were identified from the hospital records of Milton Cato Memorial Hospital, which records information on all patient coming in for healthcare services. A structured data extraction tool was employed to extract the data from the hospital record using the open data kit (ODK). Data was analysed using Statistical Package for Social Sciences (SPSS) version 23 and R Studio statistical software for analysis. The Chi-square test was used to test for association. All statistical tests were two-tailed and Level of Confidence was set at 95%, and P=<0.05 was considered to be statistically significant.

Results: The mean age of patient with SLE was 28.52 ± 13.03 years old and the median age was 30 years old, almost all 25(92.6%) were females. Every year, women showed a significantly increase in incidence of Systemic Lupus Erythematous (SLE), there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2016 (0.11/1000 person-years). The lowest incidence was noted in 2018 (0.02/1000 person-years). Among sex, there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2015 and 2016 for male (0.02/1000 person-years) and in 2016 for females (0.21/1000 person-years) respectively. The lowest incidence was noted in 2018 (0.00/1000 person-years) and (0.04/1000 person-years) for both male and female respectively. Case fatality from SLE shows that 2017 had the highest case fatality of 33% compared to the other years, 2014 (25%), 2015(25%) and 2016 (9%) with 2018 having no case fatality at all.

Conclusions: This study showed that the incidence of SLE in Saint Vincent have decreased in the last decade, whereas the mortality rates of SLE have increased. Age and sex were found to be risk factors for SLE. This discovery of increased mortality of SLE suggests that this disease is no longer rare and will have implications for future healthcare planning and health service utilizations.

Open Access Original Research Article

Appraisal of the Perceptions of Teachers on the Implementation of School Health Services in Private and Public Secondary Schools in Ebonyi State, Nigeria

Onyechi Nwankwo, Lois N. Omaka-Amari, Eunice N. Afoke, Ifeyinwa M. Okeke, Jude N. Nwafor, Precious I. Igwenyi, Michael O. Okereke, Christian O. Aleke

Asian Journal of Medicine and Health, Page 80-87
DOI: 10.9734/ajmah/2021/v19i230307

Aims: The purpose of this paper is to appraise the perceptions of teachers on the implementation of school health services in Private and Public Secondary Schools in Ebonyi State, Nigeria.

Background: Health is an essential commodity that every living human bargain for and is the prerequisite determinant of our overall achievements be it academic, social, economic and political dimesions.

Methodology: A cross-sectional descriptive design was employed to appraise the perceptions of teachers on the implementation of school health services in private and public secondary schools in Ebonyi state. Using the multistage sampling technique a total of 160 teachers who consented to participate in the study were enrolled. A self-developed questionnaire titled: Appraisal of the Perceptions of Teachers on the Implementation of School Health Service (APTISHS) was used for data collection.

Results: The findings revealed that the perceptions of teachers on the implementation of school health services in private and public secondary schools in Ebonyi state were generally poor with the Mean score 2 and 2.2 respectively. However, despite the low perception on the implementation, private schools were more favoured than public schools in areas like: Availability of personnel (P-value: 0.00); Health records (P-value: 0.00), Quality of first aid box (P-value: 0.01).

Conclusion: While efforts are made to revamp school health services in all schools, a heightened attention should be given to public schools. For an effective implementation of the school health services government should set up an implementation and evaluation committee or monitoring team. The team should composed of stakeholders from both ministries of Education and Health, school managements in both public and private including their association bodies, parent association and the communities hosting the schools. This body will facilitate issues to be agreed upon and enforcement more realistic.

Open Access Case Study

Spontaneous Negative Seroconversion of Both Hepatitis B and C in an Egyptian HD Patient

Abir Farouk Megahed, Abeer Mohammed Abd Eltwab, Amany R. Youssef, Reem Mohamed Farouk Saleh, Nagy Sayed-Ahmed

Asian Journal of Medicine and Health, Page 8-14
DOI: 10.9734/ajmah/2021/v19i230300

Background: Hepatitis b virus infection (HBV) was recognized as an important hazard for patients and staff in Hemodialysis Units (HDU), and this issue was first recognized in the 1960s with a set of guidelines for the control of HBV in HDU. HCV is a blood-borne infection and is the most significant cause of viral hepatitis which is mainly transmitted by blood transfusion. Thus, it is reasonable to perform initial screening for HCV in HD patients. Patients admitted or re-admitted to an HD unit are recommended to be tested for HBsAg, HCV, and HIV antibodies and to be followed up monthly or at least every three months after admission to HDU.

We aim to present this case of spontaneous clearance of HBV and HCV positive after being positive for more than twelve years on HD.

Case Presentation: A 66 years old Egyptian male patient with Chronic Kidney Disease (CKD) from Alexandria had started HD 14 years ago while he tested positive for HCV-Ab and HBs Ag positive, although fared well with normal liver function, while the source of infection was not known. HCV-Ab turned into seronegativity after twelve years on HD. Astonishingly, after 13 years on HD; the test of HBs Ag became negative and hepatitis B surface antibody appears by Elisa testing. This was noticed or observed following the implementation of quality enhancement of the HD parameters in most of the HD services provided units according to the regulations of Ministry of Health (MOH), and this was accompanied by better anemia and more frequent utilization of high flux dialysis with a consequent reduction to the need for blood transfusion in the last four years. Previous publications advocated hypothetical mechanisms of HCV clearance during the process of HD: namely, filtration of the virus particles through the pores of the dialysis membrane and or their adsorption to the HD membrane. These welcome spontaneous clearances of the HBV and HCV in this patient could be attributable to the improvement of anemia state and use of high flux dialysis that might have improved the immunity of this patient.

Conclusion: Spontaneous clearance of HBV and HCV could potentially possible and could benefit from the improvement of both patients and HD states that could enhance the immune system or mechanical entrapment of the virus particles. Suggestions need further studies for confirmation.