Research proposal for Assessing Patient Safety Culture in Public Hospitals under the Essential Package of Hospital Services (EPHS) in Afghanistan

Patient safety is an issue of global concern, which is sometimes missed due to the complexity of the healthcare systems. There is an increasing concern for negligence of patient safety in developing countries, especially countries with poor healthcare systems and less reliable data. In 2005, the Ministry of Public Health in Afghanistan developed the Essential Package of Hospital Services (EPHS) in order to promote quality of care in Afghan Hospitals. Patient safety, as one of the key objective of the EPHS, appears to need additional attention and evaluation. The main purpose of this research proposal is to develop a validated patient safety culture instrument and to evaluate the use of the instrument in Afghan Hospitals. The proposal introduces a framework for sampling hospitals followed by a plan for conducting a cross-sectional study using the survey instrument. The proposal also includes an assessment of the psychometric properties of the instrument. The findings achieved from the administration of the survey are intended to compare 12 dimensions of patient safety culture among different groups of providers, categories of hospitals under EPHS and the overall grade of patient safety culture within Afghanistan and with results from use of the instrument in other countries. The proposed research will have important implications for both the hospital management systems and policy making. The findings will help hospital managers and decision makers understand different dimensions of patient safety. Results should assist hospitals and health departments redesign strategies and policies that are focused on attitudes, behaviors and practices to improve the overall culture of safety. Additionally, hospitals will recognize their weak and strong points and will contribute in exchange of experiences and share their best practices

Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members

Background: Unsafe abortion is a leading cause of maternal mortality. In Afghanistan, which has experienced decades of armed conflict and where abortion is highly restricted, maternal mortality is high at 638 maternal deaths per 100,000 live births. Post-abortion care (PAC) is a lifesaving package of interventions to reduce morbidity and mortality related to induced or spontaneous abortion, but is rarely provided and often of poor quality, particularly in humanitarian settings. In July 2018, we conducted a study to identify the factors that influence access to and use of PAC services at Sharana Provincial Hospital. Methods: In-depth interviews (IDIs) were conducted with ten women who had received PAC services at Sharana Hospital, and eight focus group discussions (FGDs) were conducted with 40 married women and 40 men aged 18-45 from four villages surrounding Sharana Hospital. Results: PAC clients and community participants discussed similar barriers to seeking PAC, including cost, distance to the health facility, the need for male accompaniment to seek care, perceived and actual quality of care, stigma and shame. Despite the mentioned stigma around abortion, community members expressed willingness to help women to receive PAC. Conclusions: Our results suggest that while some barriers are not unique to PAC, others, especially those related to stigma around abortion, may be specific to PAC. It is important for the Ministry of Public Health and its partners to prioritize addressing these barriers to ensure that women have access to this critical life- saving care

Pretreatment with troxerutin protects/improves neurological deficits in a mouse model of traumatic brain injury

Traumatic brain injury (TBI) is the major and leading cause of mortality and an alarming public health challenge. TBI leads to permanent cognitive, motor, sensory and psychotic disabilities. Patients suffering from the various and long-term repercussions of TBI currently have limited therapy choices. The current research work was designed to evaluate the beneficial and neuroprotective role of Troxerutin (Trox) (a natural flavonoid) in a closed brain injury mouse model. The male BALB/c 8-weeks old mice (n꞊150) were randomly distributed in three experimental groups. Control group of mice (n꞊50), TBI group (n꞊50) and Trox pre-treated mice group (Trox + TBI, n꞊50). The mice in Trox + TBI were pre-treated with Trox (150 mg/kg, 7 days) before TBI. The weight-drop mechanism was used to induce mild-moderate injury in mice in both the groups. Our results showed that the mice pre-treated with troxerutin significantly improved neurological severity score, blood glucose level, food intake and brain edema as compared to the mice in the TBI group. Furthermore, compared to the TBI group, the mice treated with troxerutin improved cognitive behavior as evaluated by Open field test, Shallow Water Maze and Y-Maze, decreased brain-infarct volume and blood-brain barrier (BBB) permeability, significantly decreased Reactive Oxygen Species (ROS), improved neuronal morphology and survival in the brain regions such as cortex and hippocampus. In summary, our data provided evidence that pre-treatment with troxerutin improved neurological functions, decreased the BBB permeability, improved behavior, reduced ROS and increased neuronal survival in the weight-drop close head traumatic injury mouse model