Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District)

<b>Background:</b> Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. <b> Aims and Objectives:</b> To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community.<b> Materials and Methods:</b> Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50&#x0025;, of the service provider.<b> </b> Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. <b> Statistical Analysis:</b> Proportions, Likert&#x2032;s scale to grade the services and Chi-square. <b> Results:</b> Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother&#x2032;s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. <b> Conclusion:</b> Mothers education was not stressed by service providers. Service providers&#x2032; knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average

Client Satisfaction in Rural India for Primary Health Care – A Tool for Quality Assessment

Introduction: The hospital market has today changed from a seller’s market to a buyers’ market, where the patient is all-important. One needs to understand the fact that patients do not flock to a hospital just because its services are cheap, but because of its good name and good image. Objective: To evaluate client satisfaction with the government approach in primary health care. Materials and Methods: Study design: Cross sectional study Sampling: Multistage sampling. Procedure: 1) The district was stratified into taluks 1 Primary Health Center and 1 Primary Health Unit or 1 Community Health Center (where there is a CHC) from each taluk was selected using random numbers. 2) Client satisfaction was determined by systematic random sampling of clients attending the basic health services Results: Client satisfaction in availability of service was above 90% in all services except in accident care where 30% were dissatisfied. Client satisfaction for facilities and equipments was good in all services except leprosy care and tuberculosis care where it was poor. Clients were mainly unhappy with the waiting time in all the services; in few services they expected speciality care like in child care and antenatal care. High risk care during delivery was not much appreciated. Other major problem was unavailability of the health care provider which led to dissatisfaction. Family planning services were graded excellent without any drawbacks. Except for few setbacks all the services had good satisfaction by majority of clients. Conclusion: Client satisfaction is good on a whole. Key words: Client satisfaction, primary health care, efficacy to treat, antenatal care, child care Key Message: The hospital market has today changed from a seller’s market to a buyers’ market, where the patient is all-important in that context we prioritize clients in primary health care too. Clients attending primary health care were mainly unhappy with the waiting time in all the services; in few services they expected speciality care as in child care and antenatal care. Other major problem was unavailability of the health care provider at night times which led to dissatisfaction. Family planning services were graded excellent by the clients

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit