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Awareness, Practices, and Demands of Traditional Medicine Providers for Continuous Medical Education in District Hospitals of Vietnam.

ABSTRACT: Expanding traditional medicine (TM) coverage in health care is a priority in Vietnam. Continuous medical education (CME) plays an important role in ensuring the quality of TM. However, evidence about TM CME in TM practitioners in Vietnam is insufficient. This paper aimed to evaluate the awareness, practice, and demands on TM CME among TM providers in district hospitals of Vietnam. This cross-sectional descriptive study was performed at the district level at TM hospitals and TM departments of general hospitals in Thanh Hoa Province. Demographic characteristics, awareness, practice, and demand for TM CME were collected via face-to-face interviews. Descriptive statistics and multivariable logistic regression models were applied to examine the factors associated with awareness, practice, and demand for TM CME. The majority of the respondents had ever heard of TM CME (87.5%). Only 60% received TM training in the last five years. Most respondents had a demand for CME (86.8%). The non-Kinh ethnic group (OR?=?0.2, 95% CI: 0.1-0.8) and people who had a temporary contract (OR?=?0.2, 95% CI: 0.1-0.7) were less likely to be ever heard about TM CME. Higher levels of education (college, OR?=?14.1, 95% CI?=?1.0-195.9; undergraduate, OR?=?9.1, 95% CI?=?1.9-44.6) are more likely to be ever heard of TM CME than the vocational training group. Those who regularly update their knowledge are more likely to have heard about TM CME (OR?=?7.7, 95% CI?=?2.8-21.7) and are more likely to have demands on TM CME (OR?=?3.7, 95% CI?=?1.2-11.5). Those who had heard about TM CME were more likely to take these courses in the last five years (OR?=?6.9, 95% CI?=?2.5-18.8). However, this result was the opposite for people with more years of experience (OR?=?0.9, 95% CI: 0.8-0.9). There were limited awareness and participation in TM CME but was a high need for CME among TM providers at district hospitals in Vietnam. Promoting lifelong learning and providing promptly supports would be potential to increase the TM CME demands and participation among TM providers.

SUBMITTER: Nguyen TT

PROVIDER: S-EPMC7341395 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Awareness, Practices, and Demands of Traditional Medicine Providers for Continuous Medical Education in District Hospitals of Vietnam.

Nguyen Trung T TT Nguyen Quang N QN Truong Dung V DV Ngo Tam T TT Vu Ha N HN Mac Tuan D TD

Evidence-based complementary and alternative medicine : eCAM 20200628

Expanding traditional medicine (TM) coverage in health care is a priority in Vietnam. Continuous medical education (CME) plays an important role in ensuring the quality of TM. However, evidence about TM CME in TM practitioners in Vietnam is insufficient. This paper aimed to evaluate the awareness, practice, and demands on TM CME among TM providers in district hospitals of Vietnam. This cross-sectional descriptive study was performed at the district level at TM hospitals and TM departments of gen ...[more]

PMID: 32714428

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Project description:IntroductionIndia has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India.MethodsA cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities.ResultsMost of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite.ConclusionsInappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.

Project description:BACKGROUND:The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])-based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. OBJECTIVE:The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants' views of the intervention. We also developed an explanatory framework for future trial replication. METHODS:At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. RESULTS:A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians' decision to engage in higher learning, or "lateral learning," including the participant's availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. CONCLUSIONS:Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention's impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. TRIAL REGISTRATION:ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743.

Project description:ObjectivesThe present study aimed to improve breast cancer (BC) awareness and practices using Information, Education and Communication (IEC) modules and health educational sessions for women and primary healthcare providers in low socioeconomic community of Mumbai.DesignPre-post quasi-experimental design.SettingThe study was conducted in a lower socioeconomic area of G-South ward of Mumbai, Maharashtra. The baseline and endline survey was conducted using structured interview schedules.Participants410 women were selected, aged between 18 and 55 years who were not pregnant, lactating or diagnosed with BC.InterventionA health education-based intervention module was developed to educate women through group and individual sessions.OutcomesSummative indices were constructed to understand the net mean difference in knowledge of signs, symptoms and risk factors. Analysis of variance (ANOVA) and paired t-test were used to check the significant improvement of intervention.ResultsOur results showed statistical significance in difference in mean knowledge scores for both signs and symptoms (mean difference (MD) 4.09, SD 4.05, p<0.00)) and risk factors of BC knowledge (MD 5.64, SD 4.00, p<0.00) among women after intervention. There was a marked improvement in the knowledge of BC among women with low education category. A significant improvement in knowledge of symptoms and risk factors among health workers was also observed. Our interventions resulted in positive change in breast examination practices. The breast self-examination (BSE) practices improved from around 3% to 65% and around 41% additional women went for clinical breast examination after intervention.ConclusionsThis study found a significant improvement in knowledge of BC signs and symptoms, risk factors and BSE practices among study participants following our health education interventions among these subpopulations. This evidence calls for inclusion of similar interventions through health education and capacity building of primary healthcare providers in national programmes.

Project description:IntroductionAntibiotic misuse is widespread and contributes to antibiotic resistance, especially in less regulated health systems such as India. Although informal providers are involved with substantial segments of primary healthcare, their level of knowledge, attitudes, and practices is not well documented in the literature.ObjectivesThis quantitative study systematically examines the knowledge, attitudes, and practices of informal and formal providers with respect to antibiotic use.MethodsWe surveyed a convenience sample of 384 participants (96 allopathic doctors, 96 nurses, 96 informal providers, and 96 pharmacy shopkeepers) over a period of 8 weeks from December to February using a validated questionnaire developed in Italy. Our team created an equivalent, composite KAP score for each respondent in the survey, which was subsequently compared between providers. We then performed a multivariate logistic regression analysis to estimate the odds of having a low composite score (<80) based on occupation by comparing allopathic doctors (referent category) with all other study participants. The model was adjusted for age (included as a continuous variable) and gender.ResultsDoctors scored highest in questions assessing knowledge (77.3%) and attitudes (87.3%), but performed poorly in practices (67.6%). Many doctors knew that antibiotics were not indicated for viral infections, but over 87% (n = 82) reported prescribing them in this situation. Nurses, pharmacy shopkeepers, and informal providers were more likely to perform poorly on the survey compared to allopathic doctors (OR: 10.4, 95% CI 5.4, 20.0, p<0.01). 30.8% (n = 118) of all providers relied on pharmaceutical company representatives as a major source of information about antibiotics.ConclusionsOur findings indicate poor knowledge and awareness of antibiotic use and functions among informal health providers, and dissonance between knowledge and practices among allopathic doctors. The nexus between allopathic doctors, pharmaceutical company representatives, and informal health providers present promising avenues for future research and intervention.

Project description:BackgroundDespite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.MethodsA situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities' catchment area. Surveys took place in April and May 2014.ResultsHealth facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.ConclusionsNon-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.

Project description:BackgroundDespite the existence of an abortion law and a safe abortion policy in Ghana, the Ghana Statistical Service found that 15% of all women in the reproductive age group (15-49 years) have practiced unsafe abortions. The objective of this study was to explore factors that contribute to the high incidence of unsafe abortion practices in the Ashanti Region of Ghana.MethodsA qualitative descriptive study design was used to assess factors that contribute to unsafe abortion practices. Purposive sampling technique was employed in selecting participants. Data were collected through key informant interviews and focus group discussions. One hundred and eleven participants were involved in the study. Data analysis was carried out through qualitative content analysis.ResultsSeven thematic categories were elicited from data collected. The categories are: a) Lack of knowledge of safe abortion services; b) Socio-economic conditions as a perceived influence for unsafe abortion practices; c) Safe abortion as a perceived religious and cultural taboo in Ghana; d) Stigma of unplanned pregnancy; e) A desire to bear children only after marriage; f) Avoiding parental/guardian disappointment and resentment; g) A desire to pursue education.ConclusionsEvidence available in this study suggests that several factors are responsible for unsafe abortion practices in Ghana. Lack of knowledge on safe abortion services, poor socio-economic conditions, cultural and religious beliefs, a stigma of unplanned pregnancy, a desire to bear children only after marriage, attempts to avoid parental/guardian disappointment and resentment, and a desire to pursue education were cited by participants as situations that contributed to unsafe abortion practices. Measures such as Aunty Jane, Ms. Rose and Women Help Women programmes can be publicised to reduce maternal morbidity and mortality that occur as a result of unsafe abortions in Ghana. Improvement in family planning education in educational institutions needs to be considered in order to reduce the rate of unwanted pregnancies among young women in school.

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Awareness, Practices, and Demands of Traditional Medicine Providers for Continuous Medical Education in District Hospitals of Vietnam.

Publications

Awareness, Practices, and Demands of Traditional Medicine Providers for Continuous Medical Education in District Hospitals of Vietnam.

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