Tracking the origins, defi ning and quantifying quality of care: Can we reach a consensus

This editorial presents a summary of the narrative used in teaching fundamentals of quality management in healthcare to medical students and health professionals with limited or negative prior experience in the fi eld of quality monitoring and improvement – i.e. those who fi nd the topic dry and disconnected from their everyday clinical experience, lacking in human dimension, and confusing due to the multitude of de fi nitions of quality of care and the considerable inconsistency of the terminology used in quality assessment. In order to remedy the problem, the topic is presented through an historical perspective of the concept of quality as seen throughout the ages - beginning in antiquity, through 19 th and early 20 th century quality control initiatives which evolved into the quality management policies and culture now fi rmly present in many of the contemporary domains of human endeavor. It is also envisioned that specifi c tools developed in this study for didactic purposes (a new defi nition of quality of care and a framework for classifying quality indicators) may play a role in encouraging a more effective dialog among all those passionate about the issue of healthcare quality monitoring, assessment, and improvement.This editorial presents a summary of the narrative used in teaching fundamentals of quality management in healthcare to medical students and health professionals with limited or negative prior experience in the fi eld of quality monitoring and improvement – i.e. those who fi nd the topic dry and disconnected from their everyday clinical experience, lacking in human dimension, and confusing due to the multitude of de fi nitions of quality of care and the considerable inconsistency of the terminology used in quality assessment. In order to remedy the problem, the topic is presented through an historical perspective of the concept of quality as seen throughout the ages - beginning in antiquity, through 19 th and early 20 th century quality control initiatives which evolved into the quality management policies and culture now fi rmly present in many of the contemporary domains of human endeavor. It is also envisioned that specifi c tools developed in this study for didactic purposes (a new defi nition of quality of care and a framework for classifying quality indicators) may play a role in encouraging a more effective dialog among all those passionate about the issue of healthcare quality monitoring, assessment, and improvement.

Factors associated with compliance to recommended micronutrients uptake for prevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria

Background: The study investigated the factors associated with compliance to the recommended 6590-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria. Methods: A cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers. Results: There were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents (\u3c72 = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away (\u3c72 = 24.638; p < 0.001). Those in higher wealth quintile complied more (\u3c72 = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not (\u3c72 = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance (\u3c72 = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance. Conclusion: These findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy

Breast Cancer Mortality In Brazil: Correlation With Human Development Index

Background: Mortality from breast cancer decreased in high-income countries, while countries with middle and low incomes as Brazil still has upward trend. However, large geographical variations among the federal units are observed in the country. The aim of the study was to evaluate the trend of specific mortality from breast cancer in women over 20 years old years among different states of Brazil from 1996 to 2012.  Methods and Findings: Ecological study, using linear regression model for temporal analysis of specific mortality coefficient from malignant neoplasm of breast. We also checked the degree of its correlation with the HDI for the states of Brazil during the stated period. There was an increase in the specific mortality rate for malignant neoplasm of the breast in order of 33%, with range from 23.2 to 30.8 / 100,000 inhabitants. The states with the highest human development HDI in 2010, showed the largest specific mortality rates of breast cancer. Conclusion: Taking the trends of mortality from cancer an important role, this study confirms the need for improvements in mammography coverage, following radiological lesions suspected and access to appropriate therapy. &nbsp

Teaching Quality Management in Resource Limited Settings

Quality of care is a broad subject. Several modalities of quality improvement have been implemented in low resource settings with variable outcomes, including the traditional supportive supervision, 5S approach, the PARETO principle and the standards-based approach. This presentation focuses on the approach of using standards-based approach to improve the quality of healthcare in low resource settings

Factors associated with compliance to recommended micronutrients uptake for prevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria

Background: The study investigated the factors associated with compliance to the recommended ≥90-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria. Methods: A cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers. Results: There were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents (χ 2 = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away (χ 2 = 24.638; p < 0.001). Those in higher wealth quintile complied more (χ 2 = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not (χ 2 = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance (χ 2 = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance. Conclusion: These findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy