Caesarean Risk Factors in Northern Region of Bangladesh: A Statistical Analysis

Purpose: To explore the measurement of a scale of caesarean (C-section) risk factors and degree of risk contribution in different health facilities and to determine a suitable graphical representation (image) of caesarean cases.Methods: Based on seventeen indicators, a composite index was computed for each respondent and classified into three groups using Beta distribution of first kind. For the analysis of contribution of risk factors between private and public patients, principal component analysis (PCA) was also used. An attempt was made to visualise a suitable graphical representation of caesarean cases by independent component analysis (ICA).Results: The selected risk factors were more contributory to public hospital patients than to those in private hospitals on the basis of higher estimated value of range (R = 0.134) but a higher proportion of C-section occurred in private (93.4 %) than in public hospitals (30.3 %). On the other hand, PCAshowed that the contribution of selected risk factors accounts for approximately 60.0 % and 68.5 % in private and public hospitals, respectively. Furthermore, from the various graphical representation, thenumbers of private patients were more interlinked by ICA but not of the other graphical representations of PCA.Conclusion: We had expected the rate of C-section would be higher among public hospital patients than private hospital patients but the results obtained indicate the reverse. It seems that the combination of the propensity of private practice doctors to carry out C-section and the financial benefits on the part of private hospitals may be contributory factors to the caesarean section rates in private health facilities.Keywords: Caesarean risk factors, Composite index, Principal component analysis (PCA), Independent component analysis (ICA)

Optimization of CO2 production rate for firefighting robot applications using response surface methodology

A carbon dioxide gas-powered pneumatic actuation has been proposed as a suitable power source for an autonomous firefighting robot (CAFFR), which is designed to operate in an indoor fire environment in our earlier study. Considering the consumption rate of the pneumatic motor, the gas-powered actuation that is based on the theory of phase change material requires optimal determination of not only the sublimation rate of carbon dioxide but also the sizing of dry ice granules. Previous studies that have used the same theory are limited to generating a high volume of carbon dioxide without reference to neither the production rate of the gas nor the size of the granules of the dry ice. However, such consideration remains a design requirement for efficient driving of a carbon dioxide-powered firefighting robot. This paper investigates the effects of influencing design parameters on the sublimation rate of dry ice for powering a pneumatic motor. The optimal settings of these parameters that maximize the sublimation rate at the minimal time and dry ice mass are presented. In the experimental design and analysis, we employed full-factorial design and response surface methodology to fit an acceptable model for the relationship between the design factors and the response variables. Predictive models of the sublimation rate were examined via ANOVA, and the suitability of the linear model is confirmed. Further, an optimal sublimation rate value of 0.1025 g/s is obtained at a temperature of 80°C, the mass of 16.1683 g, and sublimation time of 159.375 s

Association between Knowledge and Drug Adherence in Patients with Hypertension in Quetta, Pakistan

Purpose: To evaluate the association between patient’s knowledge of hypertension management and medication adherence.Methods: A cross-sectional study was undertaken with 385 hypertensive patients who visited outpatient departments in two public hospitals in Quetta City, Pakistan. Besides demographic and disease-relatedquestions, two validated questionnaires (Hypertension Fact Questionnaire and Drug Attitude Inventory) were used for data collection. Descriptive statistics were to determine the demographic and diseasecharacteristics of the patients while Spearman rank correlation was employed to measure the association between knowledge and drug adherence.Results: Out of 385 patients, 236 (61.3 %) of the patients had average knowledge about hypertension while 249 (64.7 %) were categorized as poor adherent. No patient was considered as good adherent in the study. Correlation coefficient between total score of knowledge and total adherence was – 0.170 (p < 0.001), indicating an inverse association between knowledge scores and adherence level.Conclusion: Although the level of knowledge was average, patients were unsure of the benefits of continuous medication use which resulted in non-adherence to regimens. Educating patients about the benefits of medications and clarifying doubts regarding medication use should result in better control of hypertension

Health-Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis Relapse Patient: A Case Report from Malaysia

Purpose: To describe changes in HRQoL of pulmonary tuberculosis (PTB) patient and illustrate impact of malnutrition and Type II diabetes on relapse of PTB. Case: A Chinese male patient with complaints of productive cough, and loss of weight and appetite was registered; sputum smear confirmed that patient had PTB. Diagnosis was also supported by routine investigations. Patient had past history of PTB and Type II diabetes mellitus. For management of secondary tuberculosis, he was prescribed WHO recommended therapy. Elevated HbA1c levels and history of drop-off serum albumin concentration at the start of treatment demonstrated inappropriate glycaemic control and malnutrition over the past months. SF-36v2 was used to estimate HRQoL scores at start, after two months and at the end of TB therapy. Although patient&#8217;s perception of mental and physical health improved with progress of treatment, vitality (VT), social functioning (SF) and role emotion (RE) scores were still lower than Malaysian norms. Patient was declared &#8216;cured&#8217; but state of &#8216;health&#8217; as defined by WHO was not achieved. Conclusion: Relapse of PTB might be a consequence of inappropriate glycaemic control and malnutrition. This case report demonstrates the need for more comprehensive efforts at TB programs to improve HRQoL of TB patients.Keywords: Health-Related Quality of Life, Pulmonary tuberculosis, Malnutrition, Type II diabetes, SF 36v

Association between Hepatitis B-Related Knowledge and Health-Related Quality of Life

Purpose: To evaluate the association between patient’s knowledge of Hepatitis-B and Health Related Quality of Life (HRQoL).Methods: A cross sectional, descriptive study was undertaken with 390 hepatitis-B patients attending two public hospitals in Quetta City, Pakistan. Knowledge of hepatitis-B was assessed using a prevalidated questionnaire. European Quality of Life scale was used for the assessment of HRQoL. Descriptive analysis was used to elaborate patients’ demographic characteristics while inferential statistics were applied to report the association among study variables. Spearman’s rho correlation was used to identify the association between variables.Results: Out of 390, (230, 59.5 %) were males and the mean age of the subjects was 36.2 ± 9.2 years. One hundred and three (26 %) had primary level of education and 109 (27.9 %) were employees in the private sector. Eighty four (21 %) had a monthly income of between 10001-15000 Pakistan rupees (1 PKR = 0.0115527 USD) with 272 (69.7 %) respondents resident in urban areas. Mean HRQoL and Hepatitis-B related knowledge (HBRK) scores were categorized as poor (0.37± 0.3) and (8.52 ± 2.7) respectively. The correlation coefficient between HRQoL and HBRK was -0.102 (p &lt; 0.001), indicating a week negative association between the study variables.Conclusion: The findings indicate a negative association between Hepatitis-B related knowledge and HRQoL. Therefore, providing disease-related knowledge to patients does not necessarily improve HRQoL. More attention should be given to identify individual factors that affect HRQoL among patients with Hepatitis-B.Keywords: Health related quality of life, HRQoL, Hepatitis-B, Disease-related knowledge, Associatio

Prices and availability of locally produced and imported medicines in Ethiopia and Tanzania

Background: To assess the effect of policies supporting local medicine production to improve access to medicines. Methods: We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR). Results: The Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively. The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively. Conclusions: Our results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.Scopu