Geneva Health Forum Archive

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GHF2014 – PS25 – Raising Awareness and Promoting Healthy Lifestyles: the Proof is in the Pudding

16:00
17:30
PS25 WEDNESDAY, 16 APRIL 2014 ROOM: 13
ICON_Fishbowl
Raising Awareness and Promoting Healthy Lifestyles:
the Proof is in the Pudding

MODERATOR:
Dr. Sunoor Verma
Executive Director, Geneva Health Forum, Switzerland
SPEAKERS:
FitNation/SémioFormation: Signs of Bikes for Public Health
Mr. Rick Bell
Executive Director, American Institute of Architects New York Chapter, Center for Architecture, United States
Ms. Gwenaëlle de Kerret
Research Director and Semiotician, Harris Interactive,
PhD. Candidate in socio-semiotics, Adjunct teacher in La Sorbonne (Paris V) and Rouen International Business School (NEOMA), France
Intervention with Communication Techniques Reduce Tobacco Use in the Community: An Experience from Rural Bangladesh
Mr. Shahidul Hoque
Field Research Manager, Centre for Equity and Health Systems, ICDDR, Bangladesh
Take a Step for Diabetes
Mr. Lorenzo Piemonte
Communications Coordinator, External Relations, International Diabetes Federation, Belgium
OUTLINE:
PROFILES:

Sunoor -130Dr. Sunoor Verma

Dr. Sunoor Verma is the Executive Director Geneva Health Forum.As a senior development expert, Sunoor Verma has worked in emergency, conflict and post-conflict situations. He has led the establishment of complex partnerships and coalitions by negotiating strategic agreements and their implementation plans. He has set up programs across sectors, including, Education, Health, Protection, Injuries, Sanitation, HIV/AIDS, Harm Reduction, Conflict Resolution, Refugees, Internally Displaced Persons, Environment, Culture, Gender, Minority issues etc. He has worked in various locations, including Western Europe, South East Europe, South Asia, South East Asia, North Africa and Australia. Among others, he consulted and worked with UNHCR, UNICEF, and the European Centre for Minority Issues, Cambridge University and the Australian Society of Plastic Surgeons. Sunoor Vema has been the principal consultant of the strategy consulting practice ‘ProCube’ and is the founder of www.csrforchildren.org.

He is a seasoned speaker on the topics of strategy, partnerships and leadership. He is also sought after for his skills as an effective moderator on high-voltage panels. In a previous avatar, Sunoor Verma was a practicing cardiothoracic surgeon.

PS25_Rick Bell_squareMr. Rick Bell

I became an architect because of the inspirational oratory of professors including Vincent Scully and the physical example of buildings seen while attempting, at the age of 19, to hitchhike from Paris to Dakar. As an architect I've had three careers, first in the private sector, then at a public agency, and, most recently, in the not-for-profit domain. As a private architect, I mostly designed schools and libraries in a NYC-based firm that also did hotel projects worldwide. In the public sector, I served as chief architect and assistant commissioner of New York City's public works department, responsible for 700 projects annually. And for the last twelve years I've led the New York Chapter of the American Institute of Architects and created its storefront Center for Architecture.

Gwen profile photoMs. Gwenaëlle de Kerret

Gwenaëlle joined Harris Interactive France in 2007, where she is responsible for semiotic and ethno-semiotic research. She has been working in marketing and communication research for 8 years, on French and international topics. She specializes in projects aiming at understanding how corporations’ territory impact on public’s perceptions. These projects involve either services and cultural products, or consumer goods (packagings, products) and commercial spaces.

In parallel, she has been working for 3 years on a PhD dissertation dedicated to museums’ visual identity, in Paris and NYC. This research focuses on how museums express their identity through graphics and space (communication, architecture, signage, etc.).

PS25_Piemonte Profile Photo_squareMr. Lorenzo Piemonte

An Italian national with a background in international relations, I’ve been based in Brussels for the last fifteen years, following periods of work and study in South Africa, the USA and UK. I joined the International Diabetes Federation (IDF) in 2003 and have been involved in several activities and projects for the Federation since then, including advocacy, communications, event management and public relations. My current responsibilities include coordination of the World Diabetes Day awareness campaign and overseeing the online communications of IDF. I’ve been living with type 1 diabetes for over 20 years.

GHF2014 – PS09 – Assessing the Impact of Healthcare Institutional Partnerships

14:00
15:30
PS09 TUESDAY, 15 APRIL 2014 ROOM: 18 ICON_Fishbowl
Assessing the Impact of Healthcare Institutional Partnerships
MODERATOR:
Dr. Shams B. Syed,
Program Manager, African Partnerships for Patient Safety (APPS), Global Partnerships Lead, WHO Service Delivery & Safety (SDS), Switzerland
SPEAKERS:
The ESTHER European Alliance: a decade of hospital partnerships assessed
Dr. Nathalie Mezger
Medical senior officer, MD, DTMH, MPH, Division of Tropical and Humanitarian Medicine, University of Geneva, Switzerland
Mr. Odom Team
ESTHER Norway partnership, Cambodian School of Prothetics and Orthotics, Cambodia
Dr. Emmanuel Makasa
ESTHER Ireland partnership, Health Councillor at Permanent Mission of the Republic of Zambia to the UN, Switzerland
Dr. Georges Wilfred Bediang
Coordinator of the RAFT Network, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Switzerland
Andrew Jones
THET
Julie Storr
APPS
Eric de Roodenbeke
IHF
OUTLINE:
Institutional health care partnerships are receiving increasing attention in the global health arena. In particular, the knowledge base on how hospital-to-hospital partnerships can strengthen service delivery is rapidly evolving.  Indeed, some of this learning is starting to percolate the peer-reviewed literature. However, a large amount of this evolving knowledge currently remains confined within those involved in implementing partnerships. This session provides an opportunity to harness this tacit knowledge to inform the global knowledge pool. The focus is exploring un-answered questions and to refine collective thinking in this rapidly developing field of enquiry.Multiple inter-connected areas of institutional health care partnerships will be explored. Seven critical questions will guide both “presenters” and “analysts” in their contributions to the session.1. How can the impact of partnerships be measured?2. What defines high quality partnerships?3. What is the utility of working in thematic areas such as patient safety, medical equipment and hospital management?4. What is the motivation behind the creation of partnerships?5. How can such partnerships contribute to health development?

6. Why should hospitals in high, middle and low income countries be interested?

7. Can partnerships evolve to become truly “flat” with bidirectional flow of knowledge and ideas in the spirit of global health.

 

The synthesis of reflections on these questions and many others explored during the session has potentially profound implications for global health systems.

PROFILES:

ShamsSyedIMG_2475Dr. Shams Syed

Dr. Shams Syed currently leads WHO African Partnerships for Patient Safety (APPS). He is also responsible for global partnership development in the new WHO Department of Service Delivery & Safety. He is well-versed in the field of institutional health care partnerships, patient safety and service delivery. He is also keenly aware of the potential significance of this area of work within the global health context. His lead role in developing the Special Series on Reverse Innovation in Global Health Systems within the journal Globalization & Health gives him a keen awareness of the peer-reviewed literature on the subject. Dr. Syed has had wide experience in moderating & facilitating a range of events, sessions and workshops with a style that matches discipline with openness. His diplomatic skills are particularly suited for a controversial subject area.

 

Dr. Nathalie Mezger

Dr. Nathalie Mezger is a medical doctor, specialized in internal and tropical diseases and is involved in the humanitarian and public health medicine fields. She studied in Geneva but also took to opportunity to study elsewhere (Belgium, Thailand, Long distance course with the London School of Hygiene and Tropical Medicine).

She always tried to share her time between the Geneva University Hospitals (HUG) and the outside world.

In the HUG she worked in internal and tropical medicine and she is currently in charge of the ESTHER Switzerland development. Outside of the HUG she went on missions with MSF (Doctors without Borders) and was one of the member of the Swiss Board during 5 years. Dr. Mezger is currently working with the ICRC, in a unit in charge of the field workers’ health.

 

Exploring Primary Care: System Dynamics in USA and Romania.

Author(s) Andrada Tomoaia-Cotisel1, Karl Blanchet2, Zaid Chalabi3, Samuel Allen 4, Victor Olsavsky 5, Cassandra Butu6, Michael Magill7, Bernd Rechel8
Affiliation(s) 1Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Cluj-Napoca, United States, 2Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4Utah Medical Education Council, Utah Medical Education Council, Salt Lake City, United States, 5WHO Country Office Romania, WHO Country Office Romania, Bucharest, Romania, 6WHO Country Office Romania, WHO Country Office Romania, Bucharest, Romania, 7Department of Family & Preventive Medicine, University of Utah, Salt Lake City, United States, 8Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
Country - ies of focus Romania, United States
Relevant to the conference tracks Health Systems
Summary Policy-makers are better able to identify and implement effective health system strengthening (HSS) efforts when they have an accurate understanding of the dynamic, emergent behavior of the system they are attempting to strengthen. Achieving such an understanding is difficult. Yet, without it, decisions can easily result in unintended consequences or policy resistance. This paper describes system dynamics methodologies employed in the context of a HSS effort in Utah, USA and explores ways of applying them in LMICs, based on a case study in Romania. We present differences in data needs, availability and quality; and discuss how methods can be modified in view of these constraints.
Background Policy-makers are better able to identify and implement effective health system strengthening (HSS) efforts when they have an accurate understanding of the dynamic, emergent behavior of the system they are attempting to strengthen. Achieving such an understanding is difficult. Yet, without it, decisions can easily result in unintended consequences or policy resistance. In high-income countries, such understanding is increasingly obtained through the use of complex system modeling and detailed statistical analysis using large datasets. However, in low- and middle-income countries (LMICs) the data available are more limited, introducing higher levels of uncertainty in health system parameters. Despite this uncertainty, systems thinking and system dynamics supplies decision-makers with information needed in HSS efforts.“Systems thinking” provides a comprehensive framework for capturing, from diverse perspectives, how health systems function and how complex changes occur. System dynamics takes this approach to the next level by developing quantitative computer-based simulation models that can analyze system behavior and simulate how systems respond to policy measures and other changes over time.
Objectives To describe system dynamics methodologies employed in the context of a HSS effort in Utah, USA. Methodologies used are explained and ways of applying them in low and middle income countries are explored, based on a case study in Romania. The World Health Organization projects the burden of non-communicable diseases (NCDs) in LMICs to grow from half of total disability-adjusted life years in 2004 to three quarters by 2030. As LMIC health systems are already strained, this awareness necessitates that LMIC policy-makers anticipate and prepare for the consequences of this shift. As many NCDs are best managed in primary care settings, many HSS efforts aim to enhance primary care. System dynamics provides methods for creating custom-tailored tools to do this.HSS efforts in Romania, as in other former communist countries, focus on overcoming a previous neglect of primary health care, while redesigning the provision and financing of primary care at the same time. The goal being to facilitate patient centered care with a whole person orientation, providing all key elements of primary care.
Methodology System dynamics methodology will be presented as used in a high-income country setting and as modified for implementation in a middle-income country setting. In both contexts, the core methodology progresses as follows: 1) develop a conceptual model of the health system, 2) transpose the conceptual model to a dynamic quantitative model of the system, 3) develop and run scenarios simulating the policies and interventions under consideration. This methodology is couched within a participatory action research approach. Methodological tools employed included: Causal Loop Diagrams (CLDs) identifying key system structures such as feedback loops and time delays; statistical analyses and literature review identifying relationships among system variables; model validation techniques and key informant discussions with a diverse set of stakeholders. Decision-makers are involved throughout the project, participating in model development and critique, providing key informant expertise, designing scenarios to be tested, and discussing scenario results.We present differences in high and middle income country data needs, availability and quality. We also discuss how methods can be modified in view of these data constraints. These modifications impact the model produced and the lessons obtained from it. Strengths and limitations of these modifications are discussed.
Results We found that applying a SD methodology in LMICs is possible, but that the level of uncertainty in the model developed depends on the type and amount of available data. CLDs can be developed on the basis of interviews with key stakeholders, as well as using information in the literature. Quantifying the relationship between the identified system variables should ideally use context-specific data to increase model validity. However, model validation techniques can be performed using less data, for example via key informant discussions to elucidate a relationship’s potential behaviour. A health system model can be operationalized using less than ideal datasets. Existing data sources include qualitative and quantitative data on primary care in Romania and nationwide hospital diagnosis-related groups (DRGs) data. Additional low-cost resources would be required to conduct key stakeholder interviews to verify model structure and to design policy scenarios.
Conclusion Applying system dynamics in HSS requires the creative use of mixed methods within the constraints of data availability, transdisciplinary research teams and multi-level stakeholder involvement (of patients, providers, administrators and policy-makers). In particular, in LMICs’ HSS efforts, policy-makers need to know how to adapt innovations to their specific context and health system. System dynamics methodology promises to allow for this kind of tailoring; it also provides a framework for conceptualizing and simulating system behavior. Its design, tools and required parameterization can draw on experiences from elsewhere, while at the same time be adapted to local contexts.

Variation in Dietary Intake and Pre-eclampsia and Eclampsia in Indian women: Findings from the National Family Health Survey.

Author(s) Sutapa Agrawal1, Jasmine Fledderjohann2, David Stuckler3, Sukumar Vellakkal 4, Shah Ebrahim 5
Affiliation(s) 1South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, 2Deaprtment of Sociology, University of Oxford, Oxford, United Kingdom, 3Department of Sociology, Oxford University, Oxford, United Kingdom, 4SANCD, PHFI, New Delhi, India, 5Non communicable Disease Epidemiology, LSHTM, London, United Kingdom.
Country - ies of focus India
Relevant to the conference tracks Women and Children
Summary Pre-eclampsia/eclampsia is responsible for upwards of 20% of maternal morbidity and mortality in developing countries. We examine the relationship between food intake and symptoms of pre-eclampsia and eclampsia among Indian women aged 15-49 (n=39,657) for the most recent live birth in the five years preceding the National Family Health Survey-3 (2005-06). Daily consumption of milk, vegetables, chicken/meat and weekly pulses/beans consumption are associated with substantially lower risk of pre-eclampsia. Eclampsia risk is higher among those who consumed fruit and chicken/meat occasionally, and lower among those consuming vegetables daily.
Background Pre-eclampsia and eclampsia pose significant threats to maternal health, particularly in developing countries. In low-and middle-income settings, these two conditions affect approximately 8% of all pregnancies, causing an estimated 15%-20% of maternal morbidity and mortality. Pre­eclampsia is a life threatening complication of pregnancy that typically starts after the 20th week of gestation. Women with pre-eclampsia may present with symptoms such as headache, upper abdominal pain, or visual disturbances and have raised blood pressure, ankle oedema and proteinuria. When pre-eclampsia is left untreated or is severe, giving rise to seizures/convulsions which cannot be attributed to other causes (such as epilepsy), the condition is known as eclampsia. Although several studies have found that micronutrient deficiencies, such as iron, vitamin A, vitamin C, and calcium, contribute to pre-eclampsia risks, few studies have evaluated the potential role of different food types.
Objectives Existing nutritional evidence is highly variable. Dietary patterns may influence maternal antioxidant levels, mediating the link between pre-eclampsia and oxidative stress, an established risk factor. However, consumption of high-energy diets may increase risk of pre-eclampsia by inducing abnormal lipid metabolism, while consumption of dietary fibre may regulate these metabolic processes, thereby reducing risk. However, studies which have attempted to test these links empirically have not been conducted in high burden countries, nor have they employed appropriate multivariate models. To our knowledge, there has not been any previous large-scale report concerning the dietary risk factors for pre-eclampsia and eclampsia in Indian women. Here, we evaluate potential dietary risk factors of pre-eclampsia and eclampsia, using a large representative sample of Indian mothers in the third National Family Health Survey conducted during 2005-06.
Methodology Data were taken from the most recent wave of the National Family Health Survey (NFHS-3, 2005–2006), India’s Demographic and Health Surveys. NFHS-3 collected demographic, socioeconomic and health information from a nationally representative probability sample of 124,385 women aged 15–49. The sample is a multistage cluster sample with an overall response rate of 98%. All states of India are represented in the sample (except the small Union Territories), covering more than 99% of the country’s population. The analysis presented here focuses on 39,657 women in the sample who report being married and who have had a live birth in the five years preceding the survey. The survey was conducted using an interviewer-administered questionnaire in the native language of the respondent. To assess the occurrence of pre-eclampsia, mothers were asked if at any time during their last pregnancy they experienced relevant symptoms, including difficulty with vision during daylight, night blindness, convulsions (not from fever), swelling of the legs, body or face, excessive fatigue, or vaginal bleeding. Women who reported difficulty with vision during daylight, swelling of the legs, body, or face, or excessive fatigue were coded as having symptoms of pre-eclampsia, whereas those who reported experiencing convulsions (not from fever) were coded as symptomatic of eclampsia. Data on blood pressure and proteinuria during pregnancy were not available in the NFHS. Dietary intake variables were based on the self-reported frequency of consumption of milk or curd, green leafy vegetables, fruits, pulses and beans, eggs, fish, chicken or meat, categorised into daily, weekly, occasionally, or never. Potential confounders and covariates were selected on the basis of previous knowledge of their association with pre-eclampsia/eclampsia. We used multiple logistic regression to estimate the association between variation in dietary intake and pre-eclampsia and eclampsia risk after adjusting for maternal factors, biological and lifestyle factors and socio-demographic characteristics of the mothers. Models were adjusted for sampling weights (IIPS & Macro International 2007). All analyses were conducted using the SPSS statistical software package Version 19.
Results Overall 55.6% of mothers reported pre-eclampsia symptoms, and 10.3% reported eclampsia. Table 1 reports the results of our statistical models. After adjusting for maternal, biological, and chronic disease risk factors, as well as socio-demographic characteristics, we found that the risk of pre-eclampsia was significantly lower among women who consumed milk daily (OR:0.88;95%CI:0.81-0.96), green leafy vegetables daily/weekly (OR: 0.69 to 0.76), pulses or beans at least weekly/occasionally (ORs ranges from 0.84 to 0.92), fruits daily (OR:0.92), eggs weekly/occasionally, consumes fish (OR:0.90) or chicken/meat daily or occasionally, with added reference to those who never consumed them. However, a greater risk of pre-eclampsia was found among women consuming fruits weekly/occasionally (OR:1.11), eggs daily (OR:1.23) and fish weekly (OR:1.22). The risk of eclampsia was lower among those consuming green leafy vegetables (ORs ranges from 0.74 to 0.79), consuming fish weekly or occasionally (ORs ranges from 0.44 to 0.62), eggs weekly or occasionally (Ors ranges from 0.61 to 0.76), but was higher among those who consumed fruits (ORs ranges from 1.18 to 1.44), chicken/meat occasionally (OR:1.28;95%CI:1.11-1.48) with reference to those who never consumed them.
Conclusion Our study provides empirical evidence of an association between the frequency of intake of specific food items and prevalence of pre-eclampsia/eclampsia in a large nationally representative sample of Indian women. Findings suggest that variation in the frequency of consumption of specific foods has a substantial effect on the occurrence of symptoms suggestive of pre-eclampsia/eclampsia in this population. The strengths of our study include the large nationally representative study sample and the population-level focus on the predictors of pre-eclampsia and eclampsia. However, due to the general challenges of measuring hypertensive disorders in population-based studies, the information of the symptoms of pre-eclampsia and eclampsia presented here is based on self-reports and should therefore be interpreted with care. Although we adjusted for several confounding variables, we cannot exclude the possibility of residual confounding. In these analyses, the cross-sectional design precludes causal inferences and we were limited to the questions used to elicit lifestyle and dietary information. Few population level studies exist which assess the dietary determinants of pre-eclampsia and eclampsia. This study is important because few others have reported pre-eclampsia/eclampsia prevalence rates based on population-level data. Our study implicates that modifiable risk factors for pre-eclampsia/eclampsia exists and thus there is a need for replication of findings given that the dietary patterns are modifiable. Our study findings may serve as an important call for health care providers to heighten their awareness of the increased population-level risk for pre-eclampsia and eclampsia disease originating in pregnancy. With the target of the Millennium Development Goals in sight, pre-eclampsia/eclampsia should be identified as one of the priority areas in reducing maternal mortality in India. However, further research involving the use of a more comprehensive dietary measure, pre-pregnancy assessment of all the risk factors and ascertainment of dietary intake prior to the development of pre-eclampsia and eclampsia and accuracy of reporting of the symptoms of pre-eclampsia and eclampsia are needed in a developing country setting.

Certificate Course In Evidence Based Diabetes Management: Capacity Building of Primary Care Physicians in Diabetes Care, India.

Author(s) Shivangi Vats1, K Srinath Reddy2, V Mohan3, Sandeep Bhalla 4
Affiliation(s) 1Training, PHFI, Delhi, India, 2PHFI, PHFI, New Delhi, India, 3Dr Mohan’s Diabetes Specialities Centre, Dr Mohan’s Diabetes Specialities Centre, Chennai, India, 4CCEBDM, PHFI, New Delhi, India.
Country - ies of focus India
Relevant to the conference tracks Education and Research
Summary CCEBDM is a pan India program for the capacity building of primary care physicians in the field of diabetes. As the country is becoming the diabetic capital with a lack of trained physicians in this field this program is launched in 2010. An evaluation was done to assess the short impact of the program and it was found that the program was effective and the skills of the physicians improved after attending the training program.
Background Diabetes is considered one of the major contributors to the global burden of disease. It exemplifies management challenges because of long latency, chronicity, multi-organ involvement and long term care. In India, health system is constrained in term of trained manpower and limited institutional capacities for diabetes management. A balanced approach to equip primary care physicians with advanced and newer evidence based knowledge for better diabetes management is fundamental.
Objectives This article/paper is aimed to assess the impact and effectiveness of PAN INDIA Certificate Course in Evidence Based Diabetes Management (CCEBDM).
Methodology CCEBDM is an evidence based diabetes management course with the objective of improving the treatment outcomes for patients by serving as an evidence based guidance for clinical decision making in risk assessment, diagnosis, prognosis and management of diabetes. Improvement in knowledge of physicians was assessed by quantitative and qualitative methods. For quantitative analysis pre and post test scores were used and for qualitative analysis, end-line evaluation as a cross-sectional survey was conducted with 100 and 125 randomly selected physicians from CCEBDM Cycle-I and cycle-II respectively using pre tested scheduled questionnaires two months after completion of cycles.
Results Pre-post test scores of 2776 physicians were assessed for the knowledge improvement and it was found that there is significant improvement (P value < 0.05) in knowledge regarding basics of diabetes, pharmacological treatment, acute and chronic complications with management. Once the course was completed the frequency of treating diabetic patient/physician/month increased (38% 501 to 1,500 patients per month and 44% stated that they treated about 101 to 500 patients per month), and the confidence level of physician increased in the field of diabetes diagnoses and management. Frequency of physicians who were confident to manage diabetic complications like hypoglycaemia (73%), peripheral neuropathy (94%), skin complication (82%), sexual dysfunction (78%), diabetic foot (74%) and nephropathy (71%) increased. 90% were confident about managing patients on insulin independently.
While assessing the clinic structure it was found that 66% of physicians had provision for laboratory facilities routine blood screenings, 53% had on-site dieticians who help the diabetic patients, 35% had a counsellor to guide the patients, 49% were using DBMS, 79% had full time nurses on duty, and 76% used various forms of Patient Education Resources to elicit awareness about diabetes. The majority of the physicians agreed that the course contributed significantly to their knowledge of diabetes management and added value to their treatment skills. All agreed that curriculum was up-to-date with latest advances and guidelines and faculty’s personal clinical experience added to their teaching were very useful as now they can consult the diabetic experts anytime for references.
Conclusion CCEBDM is an evidence based course and uses recent clinical findings in developing clinical guidelines for better management of diabetic patients and is very effective in improving the knowledge of physicians and clinical practices in diabetes management. Also by building the capacity of primary care physicians in diabetes management, it seems to be a solution to control the increasing burden of diabetes and to improve the productivity of people who are living with diabetes.

Health as an indicator of sustainable development: How health can contribute to and benefit from sustainable policies.

Author(s) Natalie Mrak1, Callum Brindley2
Affiliation(s) 1Development studies, The Graduate Institute for International and Development Studies, Geneva, Switzerland, 2Development Studies , The Graduate Institute for International and Development Studies, Geneva, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Environment and Sustainability
Summary This study highlights how health can be a cross-sectoral indicator for the proposed 2015 sustainable development goals. The impacts of environmental changes on human wellbeing have been clearly established but insufficient work has been done to show how sustainable policies can also benefit health. This study recommends health indicators that can be used to measure sustainable progress in the sectors of water, food, energy, housing and transportation within the urban environment. It also provides suggestions on accountability and governance mechanisms that should put be in place at local, national and global levels to ensure that everyone takes responsibility for sustainable development.
Background Growing concerns about the impact of environmental changes on health have emerged as middle-income countries have adopted the consumption and greenhouse gas emission behaviours of high-income countries. The same economic trajectory that has created a global marketplace dependent on increasing volumes of production, consumption and the long-distance transport of goods, has also led to the overexploitation of finite natural resources, energy shortages and the overburdening of the natural environment. The affects from this trajectory not only pose challenges to the sustainability of the environment but to human health as well. About 24 per cent of the global burden of disease and 23 per cent of deaths are attributable to environmental causes and around 36 per cent of the disease burden in children is caused by environmental factors. Despite this information, health has been an omitted aspect in climate policies. The collective health benefits that can be gained from a low carbon economy have been overlooked when they can actually be motivation for further cutting greenhouse emissions. Emphasizing the joint benefits could make reducing greenhouse emissions attractive since they serve as a means towards achieving both public health and climate goals.
Objectives The primary objective of this study is to demonstrate how health is a cross-sectoral theme of sustainable development that can be used to motivate behaviour change. The secondary objective is to show how human wellbeing will be impacted if sustainable approaches to development are not pursued. Since the MDGs were established in 2000, tremendous progress has been made to improve health outcomes but this progress will become compromised if measures are not taken to improve the current state of the environment. Everyone will be impacted but particularly the poorest and most vulnerable whose already scarce access to public goods could be further compromised as governments grapple with economic devastation as result of changes in the climate and environment. Urban areas will continue to grow, unable to accommodate their expanding population, which could lead to increased food insecurity as dry arable rural lands become incapable of producing crops. Prolonged drought conditions and increased occurrence of natural disasters could also lead to water insecurity. This situation, combined with poor housing conditions, unsustainable energy sources and carbon-motorized transport will negatively impact health and the environment. The tertiary objective is to show how policies across diverse sectors can improve human wellbeing and the environment. Health can be used to measure the effectiveness of policies in various sectors as well as benefit from policies that also improve the environment. In order to tackle the health risks that environmental changes pose, an integrated, cross-sectoral approach needs to be taken since human wellbeing is not only affected by such factors as health systems as but also other factors like pollutants and physical activity. The additional objective is to analyse the opportunities and challenges to promoting more sustainable behaviour. Everyone can contribute to a sustainable future from healthcare workers to businesses as well as governments and civil society. The post-2015 development agenda provides an opportunity to implement accountability mechanisms that do not currently exist. As cities become centres of human settlement, there is also a need to implement environmental-friendly policies that enhance rather than detract from economic growth.
Methodology The main question of this study is to see how health is a cross-sectoral indicator of sustainable development. The study was conducted between June and September 2013. The search strategy sourced reports and articles primarily published by the United Nations, especially the WHO, UNICEF and UNEP as well as the below leading health and development journals. We reviewed only articles published in English and concentrated on the period from 1990 to 2012. Our principal search terms were: “health” AND “sustainable development”; “environmental burden of disease”; “healthy environment”; “urban health”; “healthy cities”; “health” and “results-based management”; “health indicators.” In total, we closely reviewed over 100 reports and articles. To analyse the literature, the following questions were posed:• How can health and sustainable development be linked?
• How is health positioned in the post-2015 development agenda and the sustainable development goals debate?
• What are the strengths and limitations of indicators
• What current health indicators exist and what are their merits?
• What lessons can be drawn from the WHO’s Healthy Cities programme?
• How can inter-sectoral cooperation be promoted?The study looks at sustainable development within the context of urban areas, focusing on five key areas – food, water, energy, households and transport. Cities were selected as the geographic area of focus since their populations are expected to continue to increase over the course of this century. The five areas of focus were selected on the basis of their strong cross-sectoral communications with health and the burden of disease from their associated risk factors. The study demonstrates how the relationship between health and sustainable development can be thought of in three ways: health contributes to the achievement of sustainable goals, health can benefit from sustainable development and health is a way to measure progress across all three pillars of sustainable development policy.
Results The results of the study clearly demonstrate that health is an integral part of sustainable development whose contributions should be considered more seriously in the post-2015 development agenda discussions. First, climate change is contributing to the increased incidence of natural disasters and disease outbreaks, increasing the global burden of disease. Second, urban areas will endure great burdens as a result of climate change, which will be primarily due to the increased migration to cities. Third, there are measures that can be implemented across sectors, which can reduce greenhouse gas and pollutant emissions as well as improve human well-being. Last, this study also found that while there is an abundance of data on health as an indicator of sustainable development and the distinctiveness of each country’s context make it difficult to discern which existing indicators are most practical and useful, there are a series of assessments that can be carried out to develop a fit-for-purpose complement of indicators. The below tool outlines the method for conducting these assessments by focusing on a country’s:• Burden of disease
• Level of economic and social development, and
• Environmental condition and pressuresTables of indicators by income-level for the health-sustainable development nexus were created. It was found that each indicator has the following four strengths;

• Relates closely to both health and sustainable development
• Relies on data that is easily accessible and reliable
• Communicates clearly a development challenge
• Facilitates practical policy interventions

The primary limitation of this study was the lack of first-hand qualitative data which is due to the top-down approach of the study. A complementary bottom-up study containing ethnographic work could help confirm these findings and provide a people centered-approach to seeing how health is an integral part of sustainable development.

Conclusion Health can be a useful focal point to promote inter-sectoral cooperation at the local level but there is unfortunately no set of health indicators that are relevant to all contexts. A drawback to the work that has been done on health as an indicator of sustainable development in urban settings has been the emphasis on the quantitative aspect of indicators. This has made it difficult to single out a set of best practices and to actually see whether these interventions improve well-being. As urban populations continue to expand in the coming decades, new approaches to urban planning need to be taken which engage a variety of stakeholders and adapt to the dynamic nature of cities. Small-scale interventions in urban areas can be key to providing insights into what does and does not work. To ensure the work on health and sustainable development continues, health needs to be an integral component of the post-2015 development agenda. The sustainable development goals of the post-2015 agenda will not be achieved if a concerted effort is not made to assist low and middle-income countries in developing and implementing renewable energy techniques as their populations and economies continue to grow in the coming decades. Mechanisms should be created that not only transfer funds but knowledge and technology as well. Governance mechanisms need to be set in place, which marry policy and scientific evidence and impose accountability. Increasing public awareness of the intricate relationship between public health and the environment could help promote sustainable behaviour and raise attention to the need of holding all stakeholders accountable. Ultimately, there needs to be commitment at all levels of government and society in order for sustainable development to become a reality.

Why Educational Interventions Fail in Changing Treatment Practices in Rural Hospitals: Evidence from Sri Lanka.

Author(s) Lalith Senarathna1, Cynthia Hunter2, Andrew Dawson3, Michael Dibley 4
Affiliation(s) 1South Asian Clinical Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, 2Sydney School of Public Health, University of Sydney, Sydney, Australia, 3National Poisons Register & Clinical Toxicology, Royal Prince Alfred Hospital, Sydney , Sydney, Australia, 4Sydney School of Public Health, University of Sydney, Sydney, Australia.
Country - ies of focus Sri Lanka
Relevant to the conference tracks Health Systems
Summary Non-adherence to education interventions is a barrier to improving hospital treatment. This qualitative exploration reveals that education interventions are capable of improving knowledge, but success of the intervention in rural hospitals depends on social dynamics of hospital and influences from the community. In these hospitals introducing new practices was easier than changing established practices. Treatments by clinicians were easily improved than practices with non-clinical staff involvements. Interventions for specific practices will be useful in improving adherence. Similarly, parallel community awareness programs to discuss changes of hospital practices will improve this situation.
Background Lack of continuous educational programs for health care workers has created a gap between standard patient treatment guidelines and actual practice in hospitals. This gap is a significance barrier in improving patient care in rural hospitals in low and middle income countries (LMICs) like Sri Lanka where rural primary care hospitals act as initial access point to health care for majority of the population. Although different educational strategies had been in use to promote clinical guidelines aimed at closing this gap for a range of disease in rural hospitals, non-adherence to educational interventions is a major issue. Reasons for this poor adherence to educational interventions in rural hospitals in LMIC settings have not been systematically studied. This lack of evidence has created difficulties in designing educational interventions to improve hospital treatment practices.
Objectives The objective of this study was to explore reasons for non-adherence to the recommendations from education intervention in rural hospitals in Sri Lanka.
Methodology This study was a qualitative exploration related to a completed cluster randomised controlled trial (Trail Registration Number ISRCTN73983810) conducted in 46 rural primary care hospitals in North Central Province of Sri Lanka to promote poisoning treatment guidelines using an outreach education approach. This study showed that recommended treatments which were to be initiated by clinicians were well adopted while other treatments with non-clinical staff involvement did not change. Practices that were not changed following the educational intervention were used to explore the reasons for non-adherence to recommendations from education interventions.
Focus group discussions were conducted with doctors, nurses and non-clinical staff members in selected interventional hospitals. A sampling framework developed using hospital capacity and staff numbers were used to select 8 hospitals from the intervention group for the data collection. Thematic analysis was conducted using transcribed records according to the principles of grounded theory.
Results This exploration showed that outreach education intervention was capable of improving knowledge of treatment guidelines and creating a positive attitude among hospital staff members. But this attitude and knowledge alone did not change the practices as recommended during the education interventions. There were other significant internal and external influences which played a major role in treatment decisions such as social dynamics within hospital and where the influence from the communities were more prominent. In rural hospitals where there is limited staff availability, even non-clinical staff perform assisting roles in patient treatments. Hence, changing long established practices for which both clinical and non-clinical staff contribute cannot be changed using interventions designed only for clinical staff. Introducing new practises or treatments are relatively easier than changing long established inappropriate practices.
In these rural hospitals, treatment decisions are shaped to meet community expectations which are, at times, not aligned with the recommendations from clinical guidelines or interventions. Hospital staff including doctors are reluctant to neglect requests from the community in fear of becoming unpopular. During the group discussions, doctors stated that that community awareness programs parallel to hospital education interventions are essential when promoting updated treatment practices in rural hospitals.
Conclusion In rural Sri Lankan hospitals, only education interventions do not improve treatment practices. Social dynamics of the hospital and expectations of the community influence treatment decisions. Hence, these factors should be considered in designing education interventions in rural hospitals, not only in Sri Lanka, but also similar settings in other low and middle income countries. Furthermore targeted interventions aimed at selected hospital staff categories or specific treatment practices would be more appropriate than common interventions for all staff. Similarly, awareness programs to educate community about changes in village hospitals and updates of treatment practices would facilitate improvements in the hospitals.

MOTHER: A Mobile-Based Voice Health Alert Tool to Create Awareness on Young Child Feeding Habits.

Author(s) Suneetha Sapur1, Kathiresan Chinnusamy2, Girija Vadlamudi3
Affiliation(s) 1Nutrition, AkkshayaFoundation Society, Hyderabad, India, 2Indian Development Gateway, Center for Development of Advanced Computing, Hyderabad, India, 3Health, Health Management Reaserch Institute, Hyderabad, India, 4
Country - ies of focus India
Relevant to the conference tracks Advocacy and Communication
Summary Background: Malnutrition in Children is extensively prevalent in India. Poor feeding practices may lead to the burden of malnutrition, infant and child mortality.Objectives: To create awareness and demand generation in the community of government health services for infant and child feeding practices with the help of Information Communication Technology (ICT)Methods: Centre for Development of Advanced Computing and the Ministry of Communications and Information has developed the ‘MOTHER’ tool to capitalize the mobile phone’s core utility of ‘voice calls’ to create health awareness among the illiterate rural community. The project was taken up where the 80% of the population owned mobile phones.
What challenges does your project address and why is it of importance? •Registration and updating of the beneficiary records in the ‘MOTHER’ system directly from remote locations was a big challenge owing to poor internet connectivity. Our field workers started collecting the beneficiary details manually in the prescribed registration forms and in the evening, records were updated online from the Mandal Headquarters.• Voice alerts are being pushed from the system to the beneficiary mobiles and it is unilateral communication (Push Method). Beneficiary can’t call back and interact with the system. To facilitate the beneficiaries queries the phone numbers of health officials of the PHCs have been circulated to the beneficiaries during registration.
•In many families, mobile phones are only with husbands who receive the voice alerts. Most of the husbands are not interested in knowing about the basic support that can be provided to women during pregnancy and child care. They feel that it is the duty of the women. Sensitizing the husbands was one of the major challenges faced by our team. As part of MOTHER project, we organized village level awareness meetings to sensitize the men to listen to the voice alerts and pass the information to their wives.
•Compared to SMS, voice calls are costlier.
How have you addressed these challenges? Do you see a solution? Challenge: Registration and updating of the beneficiary records in the ‘MOTHER’ system directly from remote locations was a big challenge owing to poor internet connectivity. The solution was that our field workers started collecting the beneficiary details manually in the prescribed registration forms and in the evening, records were updated online from the Mandal HeadquartersChallenge: Voice alerts are being pushed from the system to the beneficiary mobiles and it is unilateral communication (Push Method). Beneficiary can’t call back and interact with the system.Solution: To facilitate the beneficiaries queries the phone numbers of health officials of the PHCs have been circulated to the beneficiaries during registrationChallenge: In many families mobile phones are only with husbands who receive the voice alerts. Most of the husbands are not interested in knowing about the basic support that can be provided to women during pregnancy and child care. They feel that it is the duty of the women. Sensitizing the husbands was one of the major challenges faced by our team.
Solution: We organized village level awareness meetings to sensitize the men to listen to the voice alerts and pass the information to their wives.
Challenge: Compared to SMS, voice calls are costlier. Moreover, service providers charge based on call duration and number of calls made per month.
Solution: We designed the voice alerts such a way that each call will be less than one minute and each alert will be sent two times in a day. Only critical alerts (such as expected date of delivery) will be repeated more than 3 times.
How do you know whether you have made a difference? Who were targeted:
• pregnant women, husbands of beneficiaries, fathers of children, health care providers,
Why:
• To create demand for the health services in the community, better utilization of health services by the beneficiaries and timely monitoring by the health officials.
How was this delivered:
• Apart from better infant and child feeding practices as presented in the abstract we observed positive changes after implementations of the project.
• Repeated voice calls sensitized the family members, particularly husbands, to understand the importance of pregnancy and the care to be taken at critical stages. Improved participation of husbands and fathers in health care activities was observed.
Have you or the project mobilized others and if so, who, why and how? The project mobilized community participation and awareness created by the project helped to create demand for health services, especially for immunization as the Mother call voice alert reaches the beneficiary (pregnant women, Mother's of below 18 months) on the days of immunisation schedule as well as nutritional supplementation through the Integrated Child development Surveillance program. Beneficiaries were demanding the village health workers for immunization and the food supplements such as Egg, fruit and calorie and protein mix.It also helped to improve health workers participation as it increased the responsibility of Health workers to follow-up with registered members. The number of visits by health workers to the beneficiary house reduced, in turn helping them to effectively utilize their time in other productive works. As to corruption, beneficiaries were sensitized about the entitlements and monetary benefits from health department along with voice health alerts. The better utilization of health as well as monetary benefits was observed.There was online monitoring of the beneficiaries details by higher government health authorities especially about high risk cases of pregnancy.
When your donor funding runs out how will your idea continue to live? In spite of a few limitations and challenges faced by the Mother tool implementation, the Mother project is a successful program that creates awareness on infant and child feeding habits. The Mother pilot project has been initiated with the goal of being integrated into the national level health services, so the pilot has been implemented by involving State National Rural health Mission and the antenatal and child data collection formats used in mother project were also of National Rural health Mission (NRHM) as these formats are common across the country. The NRHM people were involved at each step of the implementation program which helped the Mother project to be taken up by the state NRHM. The scale up of the Mother project to state level has been assisted by the NRHM officials involved witnessing the effectiveness of this innovative tool to create awareness across community, in particular to rural illiterate women. At the National level NRHM is considering a scale up to entire nation in a phased manner. Considering the level of mobile penetration in India and literacy level among rural women, voice calls (MOTHER) is the best model to reach-out towards the target beneficiaries directly at an affordable cost.  The projected has been scaled up to the state level and National Rural Health Mission is adopting this tool and scaling up to the different states in phases at national level. This project has been awarded "eIndia 2012’ Public Choice Award under Health category.

The Use of Traditional Medicine: A study in Bangladesh.

Author(s) Rumana Huque1
Affiliation(s) 1Department of Economics, University of Dhaka, Dhaka, Bangladesh.
Country - ies of focus Bangladesh
Relevant to the conference tracks Advocacy and Communication
Summary The present study aimed to examine the determinants of using traditional medicine by different socio-economic groups of people, assess the marketing strategies of providers of traditional medicines, and look at the existing policies that regulate the production, marketing and supply of traditional medicines. Household survey, exit client survey and key informants interview were employed to collect data. The findings suggest that though traditional medicine is popular in both rural and urban areas, inadequate monitoring and poor implementation leads to improper preparation of medicine with low quality or even the manufacturing of such medicines without legal permission.
Background Traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses. In Bangladesh, traditional health care providers (ayurvedic, homeopathic, unanie/kabiraji and others) are common and popular in rural areas leading to low utilisation of public facilities. It is evident that the non-availability of drugs and commodities, poor access to services by the poor, imposition of unofficial fees, lack of trained providers, a rural-urban imbalance in health providers’ distribution, weak referral mechanisms and unfavourable opening hours are contributing to low use of public facilities in Bangladesh. This indicates that though the health care seeking behaviour is partly associated with the socio-economic status of the population, the supply side problems existing within the health system also influence service utilization. In this context, the present study aimed to examine the determinants of using traditional medicine, assess the marketing strategies of providers of traditional medicines and to look at the existing policies to regulate traditional medicine.
Objectives The present study aimed to examine the determinants of using traditional medicine by different socio-economic groups of people and assess the marketing strategies of providers of traditional medicines. The specific objectives are to:• Assess the perception of people about safety, efficacy and quality of traditional medicine
• Identify the reasons for preferring traditional medicines by their types and by different socio-economic groups of people, and the types of services received
• Explore the level of satisfaction of users by socio- economic category, age, and gender
• Investigate the marketing strategies of providers for selling traditional medicines
• Identify the national policy and existing regulatory mechanisms for traditional medicines
Methodology The study followed a cross sectional survey approach where both quantitative and qualitative data was collected from exit clients, providers and at the household level at a single point of time. The study was carried out in two districts: Tangail and Munshiganj. Two upazilas from each district had been chosen randomly. Household surveys were carried out to assess the extent to which people from different socio-economic groups prefer traditional medicine and the reasons for preferring traditional medicine. Household surveys gave an overall understanding of the preference for traditional medicine among the population. A total of 800 households were surveyed from the four upazilas, taking 200 from each upazila. Among the households, 400 households were selected from rural poor areas and 400 from urban/peri urban non-poor areas to include samples from different socio-economic groups. A multi-stage stratified systematic random sampling approach was adopted. Wards were selected as Primary Sampling Units (PSU) through a systematic random sampling procedure from the list of wards as documented in Community Series Population Census 2001, published by Bangladesh Bureau of Statistics. After selecting the sample wards as the PSUs, we again adopted a systematic random sampling technique to draw sample households from the wards. We followed a cluster randomization approach for selecting the households within the sample frame. A semi-structured questionnaire was used for the household survey. Randomly selected 20 exit clients of each type of traditional medicine users (160 clients from eight facilities/providers) were interviewed to assess their knowledge, attitude and practice regarding traditional medicine usage, and their level of satisfaction. This contributed to the gathering of a more specific understanding of the preference for traditional medicine among the users. A semi-structured questionnaire was used to collect data. We interviewed three policy makers within the Directorate General of Health Services and one academic. A total of 18 traditional medicine providers were also interviewed for the study. The quantitative data were analyzed by using both descriptive and analytical statistics. Transcribed qualitative data were analyzed with respect to context, process, and outcomes.
Results Traditional medicine was popular among households in study areas. Overall, 48% of the households sought treatment from traditional providers in the recent past for themselves or for any one of their family members in the study areas, while the proportion was relatively higher in Tangail (54%) as compared to Munshigonj (42.5%). It was also found that the proportion of households who used traditional medicines were higher in Sadar upazilas (51%) as compared to the remote upazilas (45%). It was evident that 47% of households who had sought treatment from traditional providers were poor defined as those whose monthly household income was less than 10,000 Taka. Households sought treatment from traditional providers generally for women and children, who suffered from fever, pain, common colds and general ailments such as anemia, helminthiasis and nutrition, eye infection, common dental diseases and ear problems. The percentage of households inclined to take treatment from traditional providers for the elderly was relatively low in both areas (15% in Tangail and 11% in Munshigonj), and a few of them sought treatment for non – communicable diseases such as diabetes, cardio-vascular disease, hypertension, heart diseases and hypertrophy of the heart. The major reasons for seeking care from traditional providers were low cost, no side effects, prompt services and most importantly the close location of the service centre which makes the service easily accessible. It was found that illiterate and little learned persons were the main clients of traditional medicine. A considerable number of exit clients were found to be familiar with traditional medicine and had been using it for quite a long period. Therefore, from the view point of effectiveness, the clients were satisfied with traditional medicine. Most of the clients of both districts claimed that they never had any side effect for using traditional medicine. Providers also distributed leaflets in popular public places, did promotion on TV through cable operators and made miking and wall paintings to attract less-educated and middle income group people. It was evident that though there exists law and policy regarding production and practice of traditional medicine in Bangladesh, the poor implementation of the law and inadequate monitoring leads to improper preparation of medicine with low quality or even the manufacturing of medicines without legal permission due to the unavailability of proper medicine testing laboratories for traditional medicines.
Conclusion Traditional medicines are believed to be made of natural products and therefore are safe and have no side effects. However, traditional medicines and practices can be harmful if the medicines are inappropriately prepared and consumed. For mainstreaming the traditional medicine into the public health system, the followings measures need to be adopted:• A proper regulatory framework is required for the quality production and safe use of traditional medicine in Bangladesh. Given the heterogeneity of the service provision by the traditional providers, a monitoring and regulation mechanism needs to be developed to ensure quality of service provision. Governments should take the necessary measures to strengthen drug administration to ensure the quality of traditional medicine.• An appropriate medicine testing laboratories service must be introduced to ensure the quality of Unani, Ayurbedic and Homeopathic medicine.• Government needs to establish training centres for service providers and manufacturers of traditional medicine.

• Initiative should be taken by government and NGOs to increase awareness among the population about the service variety and quality of traditional medicine.

• Further research should be done on the cost-effectiveness of traditional medicines, pharmacology of natural products, characterization of natural products, synthesis of natural products, product development and possibility of commercialization of traditional medicine.

Nicotine Patch Dispensing Behaviour of Pharmacists in Drugstores: Chiang Mai, Thailand.

Author(s) Suntheep Batra1
Affiliation(s) 1Department of Pharmaceutical Care, Faculty of Pharmacy, Payap University, Chiang Mai, Thailand.
Country - ies of focus Thailand
Relevant to the conference tracks Chronic Diseases
Summary Community pharmacists in Chiang Mai, Thailand had good knowledge of, but extremely sub-optimal dispensing behaviors of nicotine patches. This is particularly in relation to advising specific usage instructions of the nicotine patch and assessing nicotine dependence and willingness of smokers to quit. This information will be useful to guide and raise the awareness of community pharmacists in dispensing nicotine patches and providing counselling for smoking cessation.
Background Tobacco use is the most important public health problem globally, and a risk factor for many acute or chronic diseases which are the leading preventable cause of death in the world. In Thailand, 14.3 million people (27.2%) are current tobacco users, and 12.5 million people (23.7%) currently smoked tobacco. Smoking killed 42,000 Thai smokers every year or 4.7 deaths in every hour. Pharmacotherapy is one of the success keys to smoking cessation. Community pharmacists can dispense these medicines without prescription in drugstores in Thailand and also have an important role in smoking cessation counselling. Thus, the pharmacists must have good knowledge of the usage instructions of these medicines, especially nicotine gum and patch which require special technique usage instructions, as well as counselling skills in order to improve drug therapy and smoking cessation effectiveness. The pharmacists’ behavior in dispensing nicotine gum has been studied before in Thailand, but the interpretation of the study was limited by small sample size. Furthermore, no data on the nicotine patch dispensing behavior of pharmacists in drugstore are available in Thailand. Therefore, it is important to evaluate nicotine patch dispensing behaviors and knowledge of community pharmacists.
Objectives The objectives of this study were to evaluate nicotine patch dispensing behaviors and knowledge of community pharmacists in Chiang Mai, Thailand.
Methodology In this cross-sectional descriptive study, 54 pharmacists who practiced in drugstores in Muang district, Chiang Mai, were enrolled by purposive random sampling. Pharmacists who practiced in drugstores where nicotine patches were not available, were excluded. The pharmacists’ behaviors in dispensing nicotine patches were observed by the mystery client technique. After a month, pharmacists’ knowledge about nicotine patch was assessed by the self-completion knowledge questionnaire. Data were collected between 1 July 2012 and 30 September 2012, and were analyzed by descriptive statistics, expressed as median (IQR) or n (%), as appropriate.
Results The results found that the median score of pharmacists’ behaviors about dispensing nicotine patches was 7.0 (4.0 – 12.0) from a total of 25. Choosing the appropriate dosage of a nicotine patch for smokers (94.4%) was the most frequently practiced behavior of pharmacists during the dispensing of a nicotine patch. However, advising about usage instructions of nicotine patch, and assessing nicotine dependence and willingness to quit of smokers were practiced by less than 20.0% of pharmacists. In term of knowledge, 48 pharmacists cooperated with the study questionnaire (response rate 88.9%). The median score of pharmacists’ knowledge about nicotine patch was 10.0 (9.0 – 12.0) from a total of 14. Almost every pharmacist (91.7%) knew about adverse drug reactions and prevention of these reactions from the nicotine patch, but most of them (72.9%) didn’t know about usage instructions of the nicotine patch.
Conclusion This study has demonstrated that the community pharmacists in Chiang Mai, Thailand had a good knowledge, but extremely sub-optimal dispensing behaviors of nicotine patches, especially in advising specific usage instructions of nicotine patch and assessing nicotine dependence and willingness to quit of smokers.