- Email: [email protected]
What led to low (70%) polio immunization coverage during the first ever national immunization days (NIDs) in Busiis subcounty Hoima district
HEALTH SOCIAL SCIENCE ‘‘CHALLENGES IN CONDOM PROMOTION: AN ASSESSMENT OF CONDOM USE IN MBARARA MUNICIPALITY MARCH–MAY 1997.’’ M. Amanyire, Z. Karyabakabo, F. Ssengooba, J. Konde–Lule, L. Marum, and M. Muganwa. Public Health Schools Without Walls, Makerere University, Kampala, Uganda. Objective: To provide information to guide the design of condom promotion activities in Mbarara District. Design: A descriptive cross-sectional study. Setting: Government health units, private clinics and drug shops that supply/sell condoms within the municipality were purposively selected. (24 condom outlets selected). Participants: Clients who bought or got condoms from government health units, private clinics and drug shops were conveniently interviewed using a guided questionnaire in a period of two months (March–May 1997). Main Outcome Measure(s): Social demographic characteristics of people using condoms, reasons for using condoms, knowledge about condom use, source of information about condom use, ability to describe how a condom can be used, type of condoms preferred, dissemination of information on condom use and patterns of condom sales. Results: A total of 192 clients were interviewed (129 males with a mean age of 31.3 years and 63 females with a mean age of 29.1 years). Most condoms were bought from drug shops 74% (142/192), private clinics 20% (38/ 192), and government health units 6% (12/192). Eighty one percent (152/ 192) had a formal education above 7 years. More males had learned about using condoms from friends 41% (52/128) than females 30% (18/62). More females had learned about using condoms after attending a seminar 55% (34/62) than males 30% (37/128). Ten percent (18/190) had taught themselves how to use condoms. Of these, only 27% (5/18) could describe proper condom use. While 87% of males (111/128) were using condoms due to fear of HIV and 11% (14/128) due to family planning, 60% (37/62) of females used condoms due to family planning and only 39% (24/62) used condoms due to fear of HIV. Of the 6 types of condoms seen, protector condom sold to 62%(117/192). Focus group discussions revealed protector condom is highly marketed with incentives at all levels. Only 21%(5/24) of distributors talk to clients about condom use. Conclusions: Most clients bought condoms from drug shops and private clinics. The males were aware of condoms as a protective measure, while the females regarded condoms as means for family planning. Being taught by someone who is knowledgeable about condom use is protective against improper use of a condom (OR 5 0.12 [0.03 , OR , 0.040]). The young adults are not using condoms. All adults should be targeted for condom use and special programs initiated for the less educated.
‘‘FAMILY PHYSICIANS’ AWARENESS AND UNDERSTANDING OF COPD IN THE PHILIPPINES.’’ Renato B. Dantes, C. C. Roa, E. V. Gaerlan, and R. L. Ruiz. CEU, University of the Philippines, Manila, Philippines. Introduction: The shift of attention of the tobacco industry to third world countries, together with the worsening of the air pollution problem in the Philippines, has made chronic obstructive pulmonary disease (COPD) a major health concern in the Philippines. The fact that COPD patients are afflicted with the disease during their most productive years and that the disease is very disabling, the economic burden of the disease to the country can be considered big. Prevention and early recognition are considered the keys to reducing the burden of this incurable disease. And family physicians play a key role in these interventions. Objective: This study was done to determine Filipino physicians’ awareness of COPD, their use of spirometry to establish diagnosis, and the correlation of their awareness with different modalities for medical education. Methodology: A cross sectional study was done using a validated selfadministered questionnaire given to 335 family physicians randomly selected from a national directory of family physicians. Respondents were asked to give their impression, work-up and management of a hypothetical case of a 55 year old, male, jeepney driver, smoker with recent respiratory tract infection and persistent productive cough who had an earlier impression of chronic bronchitis. Results: Of the 237 respondents, 137 (58%) gave a diagnosis of COPD. Only 43/137 (31%) would use a spirometer to establish the diagnosis. The awareness was significantly correlated with previous residency training and number of years in practice but not with their continuing medical education (CME) activities. Conclusion: It is concluded that (1) Filipino family physicians may have limited ability for early recognition of COPD; (2) spirometry is underused; and (3) current CME activities for these physicians are inadequate to remedy the situation.
‘‘WHAT LED TO LOW (70%) POLIO IMMUNIZATION COVERAGE DURING THE FIRST EVER NATIONAL IMMUNIZATION DAYS (NIDs) IN BUSIISI SUBCOUNTY HOIMA DISTRICT?’’ Matthew Emer, G. Oundo, F. Ssengooba, M. Muru, L. Marum, and M. K. Muganwa. Public Health Schools Without Walls, Makerere University, Kampala, Uganda. Objective: To investigate and determine the factors that led to low polio immunization coverage. Design: A cross sectional study with cluster sampling techniques was done. Standard questionnaires were administered to 161 households selected by systematic random sampling. Three political leaders as key informants were interviewed, and 3 focus-group discussions held, including one of vaccinators, one of adult males and one of adult females. Setting: The study was conducted in one of the 12 Subcounties of Hoima district, Uganda. Participants: The study units were 161 households in 18 village clusters. Interventions: None. Main Outcome Measure(s): Prior access to, and understanding of, information about mass polio immunization related to polio vaccination on NIDs. Results: Most participants knew about polio and its prevention through routine polio vaccination but did not appreciate the need for the mass immunization. Main reasons for not vaccinating on NIDs were: fear of polio vaccine contamination with HIV/AIDS virus, expired vaccine and many children already immunized by routine vaccination. Of the 161 parents interviewed, 88.9% (95%, CI 83–93) had heard about mass polio immunization but only 51% (CI 44–59) knew the aim. There was no significant difference in polio vaccination between those who had heard the information, 132/143 (92%) and those who had not 17/18 (94%), (p 5 0.6). There was no significant difference in positive attitude to polio vaccination on NIDs between those who knew the aim, 72/82 (88%), and those who did not know, 52/57 (91%), (p 5 0.69). Conclusion: Information on mass immunization was widely spread, but the concept of eradication was not explained. This encouraged negative rumors affecting turn up. Retraining of mobilizers, emphasizing how to explain the concept of eradication and assuring parents about the safety of the vaccine were recommended. Retraining is being done currently.
‘‘SEXUAL PRACTICES AFTER SURGERY FOR A BENIGN GYNECOLOGIC CONDITION.’’ Mario R. Festin and C. KoaMaminta. CEU, University of the Philippines, Manila, Philippines. Objective: To determine the knowledge, attitudes, and practices of Filipino women on sexual relations before and after gynecologic surgery for benign disease. Design: Women with benign gynecologic diseases were prospectively interviewed by a female on their sexual beliefs and practices, before and after surgery (two weeks and two months after). Setting: Tertiary university hospital in urban metropolis. Participants: Seventy-five women less than 50 years old with one stable sexual partner with benign gynecologic disease for surgery and not on hormone replacement therapy were included. Intervention: A private interview lasting less than 30 minutes was conducted each time for each patient. Main Outcome Measure(s): Rates of sexual relations with partner before and after surgery, timing of resumption of sexual relations after surgery, reasons for delay of sexual relations. Results: 27 (36%) had not resumed sexual relations after two months. The median frequency of sex before and during the illness was the same (at least once weekly) but this declined to twice per month after the surgery among those who had resumed. 35 (46.7%) noted a decrease in the desire for sex after surgery. No one reported a change in rates of orgasm after operations. Resumption of sexual relations was earlier among those who had adnexal surgery alone (38 days) compared to those who had hysterectomies (60 days). Most common reasons for delay were the concern for wound healing and the lack of advice. Only 29 (38.7%) received any advice on sexual relations after surgery, with a third of them having initiated asking for the advice from their doctor. Conclusions: Sexual relations after gynecologic surgery are often delayed because of the lack of patient education. Gynecologists should include this topic in the pre-operative counseling of patients.
34S
‘‘FAMILY PHYSICIANS’ AWARENESS AND UNDERSTANDING OF COPD IN THE PHILIPPINES.’’ Renato B. Dantes, C. C. Roa, E. V. Gaerlan, and R. L. Ruiz. CEU, University of the Philippines, Manila, Philippines. Introduction: The shift of attention of the tobacco industry to third world countries, together with the worsening of the air pollution problem in the Philippines, has made chronic obstructive pulmonary disease (COPD) a major health concern in the Philippines. The fact that COPD patients are afflicted with the disease during their most productive years and that the disease is very disabling, the economic burden of the disease to the country can be considered big. Prevention and early recognition are considered the keys to reducing the burden of this incurable disease. And family physicians play a key role in these interventions. Objective: This study was done to determine Filipino physicians’ awareness of COPD, their use of spirometry to establish diagnosis, and the correlation of their awareness with different modalities for medical education. Methodology: A cross sectional study was done using a validated selfadministered questionnaire given to 335 family physicians randomly selected from a national directory of family physicians. Respondents were asked to give their impression, work-up and management of a hypothetical case of a 55 year old, male, jeepney driver, smoker with recent respiratory tract infection and persistent productive cough who had an earlier impression of chronic bronchitis. Results: Of the 237 respondents, 137 (58%) gave a diagnosis of COPD. Only 43/137 (31%) would use a spirometer to establish the diagnosis. The awareness was significantly correlated with previous residency training and number of years in practice but not with their continuing medical education (CME) activities. Conclusion: It is concluded that (1) Filipino family physicians may have limited ability for early recognition of COPD; (2) spirometry is underused; and (3) current CME activities for these physicians are inadequate to remedy the situation.
‘‘WHAT LED TO LOW (70%) POLIO IMMUNIZATION COVERAGE DURING THE FIRST EVER NATIONAL IMMUNIZATION DAYS (NIDs) IN BUSIISI SUBCOUNTY HOIMA DISTRICT?’’ Matthew Emer, G. Oundo, F. Ssengooba, M. Muru, L. Marum, and M. K. Muganwa. Public Health Schools Without Walls, Makerere University, Kampala, Uganda. Objective: To investigate and determine the factors that led to low polio immunization coverage. Design: A cross sectional study with cluster sampling techniques was done. Standard questionnaires were administered to 161 households selected by systematic random sampling. Three political leaders as key informants were interviewed, and 3 focus-group discussions held, including one of vaccinators, one of adult males and one of adult females. Setting: The study was conducted in one of the 12 Subcounties of Hoima district, Uganda. Participants: The study units were 161 households in 18 village clusters. Interventions: None. Main Outcome Measure(s): Prior access to, and understanding of, information about mass polio immunization related to polio vaccination on NIDs. Results: Most participants knew about polio and its prevention through routine polio vaccination but did not appreciate the need for the mass immunization. Main reasons for not vaccinating on NIDs were: fear of polio vaccine contamination with HIV/AIDS virus, expired vaccine and many children already immunized by routine vaccination. Of the 161 parents interviewed, 88.9% (95%, CI 83–93) had heard about mass polio immunization but only 51% (CI 44–59) knew the aim. There was no significant difference in polio vaccination between those who had heard the information, 132/143 (92%) and those who had not 17/18 (94%), (p 5 0.6). There was no significant difference in positive attitude to polio vaccination on NIDs between those who knew the aim, 72/82 (88%), and those who did not know, 52/57 (91%), (p 5 0.69). Conclusion: Information on mass immunization was widely spread, but the concept of eradication was not explained. This encouraged negative rumors affecting turn up. Retraining of mobilizers, emphasizing how to explain the concept of eradication and assuring parents about the safety of the vaccine were recommended. Retraining is being done currently.
‘‘SEXUAL PRACTICES AFTER SURGERY FOR A BENIGN GYNECOLOGIC CONDITION.’’ Mario R. Festin and C. KoaMaminta. CEU, University of the Philippines, Manila, Philippines. Objective: To determine the knowledge, attitudes, and practices of Filipino women on sexual relations before and after gynecologic surgery for benign disease. Design: Women with benign gynecologic diseases were prospectively interviewed by a female on their sexual beliefs and practices, before and after surgery (two weeks and two months after). Setting: Tertiary university hospital in urban metropolis. Participants: Seventy-five women less than 50 years old with one stable sexual partner with benign gynecologic disease for surgery and not on hormone replacement therapy were included. Intervention: A private interview lasting less than 30 minutes was conducted each time for each patient. Main Outcome Measure(s): Rates of sexual relations with partner before and after surgery, timing of resumption of sexual relations after surgery, reasons for delay of sexual relations. Results: 27 (36%) had not resumed sexual relations after two months. The median frequency of sex before and during the illness was the same (at least once weekly) but this declined to twice per month after the surgery among those who had resumed. 35 (46.7%) noted a decrease in the desire for sex after surgery. No one reported a change in rates of orgasm after operations. Resumption of sexual relations was earlier among those who had adnexal surgery alone (38 days) compared to those who had hysterectomies (60 days). Most common reasons for delay were the concern for wound healing and the lack of advice. Only 29 (38.7%) received any advice on sexual relations after surgery, with a third of them having initiated asking for the advice from their doctor. Conclusions: Sexual relations after gynecologic surgery are often delayed because of the lack of patient education. Gynecologists should include this topic in the pre-operative counseling of patients.
34S