Can the Delhi Government’s ‘Mohalla’ clinic overcome its challenges and provide quality health services to the urban poor population?

The ‘Mohalla’ clinics were set up by the Delhi state (provincial) government in India in 2014 to provide basic health services to people of Delhi city and its vicinity, especially targeting the urban poor. The Mohalla clinics are staffed by a doctor, a nurse, a pharmacist and a laboratory technician and they provide basic health services including immunisation, family planning and counselling services. The Mohalla clinic program had a good start and its operation was cost-effective; however, it is still struggling to increase its coverage to entire Delhi state as it had planned. The program got caught up in the central government and state government bureaucratic tussle, especially on the issue of acquiring land for setting up such clinics and on the implementation front due to the lack of operational plan and collaboration with the government line agencies. Thus, despite political will and funding a potentially viable urban health program may have got stuck in the operational procedural complexities and political-bureaucratic tussle. This commentary article tries to discuss the challenges faced by the Delhi government’s ‘Mohalla’ clinics and a possible way forward to scale it up as a model urban health program. Keywords: Access; Delhi government; health services; ‘Mohalla’ clinics; urban health DOI: http://doi.org/10.3126/jkahs.v2i2.2518

Translation and cultural adaptation of EORTC QLQ-LC 29 into Nepalese language for lung cancer patients in Nepal

Background: The quality of life (QoL) of patients with lung cancer (LC) may be affected by disease-related limitations such as patients’ functioning, the severity of symptoms, financial problems resulting along with the side effects of the treatment. The objective of this study was to translate LC-specific QoL questionnaire EORTC QLQ-LC29 into Nepalese language for Nepalese LC patients. Methods: In the process of translation, the European Organization for Research and Treatment of Cancer (EORTC) translations guidelines were followed. The translated questionnaire was pilot-tested in a sample of 15 patients with LC. Descriptive statistics were calculated with SPSS version 21.0. Results: All steps of the EORTC translation guideline were followed successfully. Fifteen lung cancer patients were included in the pilot study. Sixty percent were male and the mean age was 49.87 (range 21–76 years). For all items not related to thoracic surgery, patients used the entire range of the response options from 1 to 4 and no missing responses were observed. The highest mean (indicating a high symptom burden) was observed for the item number. 35 (shortness of breath; Mean = 3.33, SD = 1.11) and the lowest mean for an item number. 45 (dizzy; Mean = 1.73, SD = 0.96). Conclusion: The Nepalese version of EORTC QLQ-LC29 is a result of a successfully conducted rigorous translation procedure, and is highly comprehensible as well as acceptable to Nepalese LC patients. Thus, the Nepalese version of EORTC QLQ-LC29 is ready to be used in international clinical studies as well as in Nepalese clinical practice

Impact of community pharmacy-based educational intervention on patients with hypertension in Western Nepal

Background There is a paucity of data regarding the feasibility and impact of community pharmacy-based educational interventions on the management of chronic diseases in developing countries. AimsThe aim of this study was to establish the feasibility, and to investigate the impact, of community pharmacy-based educational intervention on knowledge, practice, and disease management of patients with hypertension in Western Nepal.MethodA single-cohort pre-/post-intervention study was conducted from August 2012 to April 2013. The participants included in the study were patients diagnosed with hypertension attending a pharmacist-led hypertension clinic. The educational intervention was conducted by pharmacists, was individualized, and consisted of three counseling sessions over a period of six months. The patients’ knowledge of hypertension, their practice of lifestyle modification and non-pharmacological approaches concerning hypertension management, and blood pressure were assessed at baseline and again after 9 months by using a pre-validated questionnaire. ResultsFifty patients met the inclusion criteria and were enrolled in the study. The median (IQR) knowledge score changed from 6 (4) to 13 (0) after the intervention (

Types and outcomes of pharmacist-managed travel health services: A systematic review

Background and aim: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. Methods: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. Results: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94–100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%–94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. Conclusion: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations

Assessment of awareness, knowledge, attitude, and the practice of vitamin D among the general public in Malaysia

Introduction: Vitamin D deficiency is becoming a global epidemic, which is still undertreated despite increased treatment availability and increase in therapeutic options. This study aimed to explore the awareness, knowledge, attitude and practices regarding Vitamin D among the general public in Malaysia. Methods: A cross-sectional survey was carried out in a public area using a convenience sampling technique to recruit participants around Selangor and Kuala Lumpur shopping malls area. An anonymous self-administered questionnaire was used for data collection and it was circulated to 603 Malaysian. A total of 400 participants were completed and returned to the researchers.   Result: Although 90.5% of the participants have heard/learnt about Vitamin D. About 78.0% of them showed limited knowledge about some aspects of Vitamin D with (mean ± SD = 1.78 ± 0.894). Additionally, there was a negative attitude towards Vitamin D and sunlight exposure. For instance, nearly 70.0% of the respondents did not like to expose themselves to sunlight.  Only 30.0% of the participants had taken Vitamin D supplement before. There is a small, positive correlation between the knowledge score and education level, rho = 0.124, n = 400, P = 0.013, with a higher score associated with higher education level. Conclusion: The findings provided a piece of contemporary real-world evidence on the lack of knowledge and practices about Vitamin D among the general public. Therefore, extensive health educational campaigns for the public should be implemented by the government to raise their knowledge on the importance of Vitamin D. Keywords: knowledge; practice; vitamin D; public; Malaysia DOI: https://doi.org/10.3126/jkahs.v2i3.2664

Impact of the first phase of COVID-19 pandemic on childhood routine immunisation services in Nepal : a qualitative study on the perspectives of service providers and users

Abstract: Background: The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic. Methods: Semi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet. Results: A total of 15 participants (n = 7 service providers and n = 8 service users) participated. Six themes were identified, namely: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) Biosafety practices and Personal Protective Equipment (PPE) availability during the COVID-19 pandemic; (4) service adjustments and guidelines during pandemic; (5) availability of vaccines; and (6) immunisation program resilience in view of COVID-19. Service providers mentioned facing disruptions in services and some parents had decided to delay scheduled immunisation. However, most service providers showed determinations to deliver the services with high morale, while most service users reported taking their children for immunisation. Families migrating from urban to rural areas during the pandemic led to service providers having no means to confirm complete immunisation of migrating children. Service providers also experienced lack of adequate guidance to deal with the pandemic and personal protective equipment to protect themselves and service users. Conclusion: Despite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics

Access to palliative care: discrepancy among low-income and high-income countries

Recent advances in technology have led to the expansion of treatment options that can sustain life in circumstances where this was previously impossible [1]. The advancement in treatment options, while a societal success, presents many challenge to health care systems. The greatest challenge of this century is how we care our loved ones who are granted greater longevity but a cure is out of reach. As the global population is ageing and growing, the incidence of chronic disease and life limiting illnesses are also increasing. Patients with life limiting illnesses such as advanced cancer, end stage organ failure, neurodegenerative disease, and AIDS should have access to appropriate health care and basic medications intended for their pain and symptom control, enabling them to live as well as possible, and die with dignity and comfort [2]..