Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 2328   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 6  |  Page : 951-959

Factors affecting routine medical screening among health workers in a tertiary hospital in Delta State


Department of Surgery, Delta State University, Abraka, Delta State, Nigeria

Date of Submission03-Feb-2022
Date of Acceptance03-May-2022
Date of Web Publication16-Jun-2022

Correspondence Address:
Dr. C I Otene
Department of Surgery, Delta State University, Abraka, Delta State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_91_22

Rights and Permissions
   Abstract 


Background: Routine medical screening usually involves periodic history taking, physical examination, and laboratory tests on a regular basis for asymptomatic individuals for continuing self-health care. Aim: This study aimed to determine the knowledge, practice, and factors affecting practice of routine medical screening among health workers in Delta State University Teaching Hospital, Oghara. Subjects and Methods: The study population comprised all staff of the hospital. The sample size was determined using the Yamane formula; n = N/1 + N (e) = 295. A structured questionnaire was distributed among the various staff of the hospital that consented to participate in the study by agreeing to complete the questionnaire. Permission for the study was obtained from Ethics committee of the hospital. Data analysis was by SPSS version 22 (IBM). Results: About 297 participants completed their questionnaires. Female respondents (53.20%) participated more than males (46.80%). Nurses made up 25.5%, 18.8% were doctors, and 16.4% were administrative staff. Among the respondents, knowledge score was good in 58.3%, fair in 25.1%, and poor in 25.1%. The perception score among the respondents was good in 187 and poor in 110. The main reasons for not doing routine medical screening in the last one year were attributed to cost of tests (36.4%). The main reasons for doing a medical test in the past one year were mainly because of illness (60.0%). The practice of routine medical screening score was good in (26.2%) and poor in (73.7%). There was statistically significant association between sex and practice of routine medical screening, females had better practice of routine medical screening compared to men, P = 0.004. The main factors that affected routine medical screening were sex, being managed for a medical condition, and cost of the medical screening. Conclusion: The practice of routine medical screening by the health care workers in our region is poor despite the demonstration of a good knowledge. The major factors affecting uptake of routine medical screening were sex, history of being managed for a health condition, and financial constraint. Staff of the hospital should be better enlightened on the use and importance of the Contributory Health Scheme in routine medical screening.

Keywords: Delta state, health workers, routine medical screening


How to cite this article:
Abadom E G, Otene C I. Factors affecting routine medical screening among health workers in a tertiary hospital in Delta State. Niger J Clin Pract 2022;25:951-9

How to cite this URL:
Abadom E G, Otene C I. Factors affecting routine medical screening among health workers in a tertiary hospital in Delta State. Niger J Clin Pract [serial online] 2022 [cited 2022 Aug 8];25:951-9. Available from: https://www.njcponline.com/text.asp?2022/25/6/951/347627




   Introduction Top


Routine medical screening is a periodic health care process usually done by health care facilities for both genders and for all age groups at different periods of time according to the patient risk factors.[1] The components of the screening usually involves history taking, physical examination, and laboratory tests by physicians on a regular basis for asymptomatic individuals for continuing self-health care.[1] It is also known as periodic health evaluation, annual physical, comprehensive medical examination, general health check, or preventive health examination.[2] It can also be called periodic medical examination.

Routine medical screening has been documented as a preventive medical practice serving as a superior strategy to decrease the mortality and morbidity of different diseases in communities.[3] It can also be used to assess the well-being status of especially the elderly (because they are more susceptible to chronic diseases); it establishes physician–patient relationship and it lowers the need for health consultations.[4] The potential benefits of screening include the early detection of diseases, the prevention of serious illness or disability, and improved survival.[5],[6] However, not all screening procedures have shown benefits as some may cause harm to the health of the individual.[7]

Health workers who directly or indirectly administer these screening processes and procedures are not exempted from being part of the community to be screened. Irrespective of the cadre and category of work in health facilities, they should be the first beneficiaries of routine health checks. However, some studies have shown poor compliance among health workers in different parts of the world.

In a study done in the United Kingdom, about 61% of nurses did not seek medical attention despite back pain[8], whereas in Sao Paulo, Brazil only about 6% of health workers had ever gone for screening for colorectal cancer.[9] In Israel, 67% of family physicians do not have a regular physician for themselves and up to 72% of them often embark on self-medication.[10] Similarly, in a report from South Africa, 71.5% of doctors often treated themselves and their families, and about 14.5% had never gone for medical checkup.[11] In Kwara State, Nigeria, Fawibe et al.[12] found that 80.5% of Nigerian doctors reported one form of illness or the other in the last one year preceding the study and only 35% of them reportedly consulted another doctor. Majority (61.2%) of these consultations were informal, such as over the phone consultation (45.6%), corridor consultation (33.3%), and home visit (21.1%) and only about 18% of the consultations occurred within 24 hours of the illness.

Bana S, et al.[13] noted that health workers are at a higher risk of avoiding health-seeking behavior because they believe they are aware of the diseases and their symptoms as well as the pharmaceutical management of the disease. Other factors affecting health-seeking behavior of health workers include time pressure, fear of showing weakness or lack of knowledge, and concerns about confidentiality.[12] Furthermore, they are also exposed to resistant strains of a variety of microbes known to be resident in hospital environments, making them susceptible to severe and difficult-to-treat illnesses.[12] Another study in Nigeria also noticed that they are often busy with patients care and professional training leaving them with little or no time to take care of other aspects of life including seeking health care.[14]

This study aimed to determine the knowledge, perception, and practice of routine medical screening among health workers in Delta State University Teaching Hospital, Oghara, which is the only teaching hospital in Delta State. It also sought to identify factors that affect the practice of routine medical screening among health workers in Delta State University Teaching Hospital with a view to making recommendations to the management of the hospital and the State Government for policies aimed at improving the practice of routine medical screening.


   Materials and Methods Top


This was a cross-sectional study carried out among staff of Delta State University Teaching Hospital, a tertiary institution located in Delta State, South-South geopolitical zone of Nigeria using a semi-structured questionnaire.

Delta State University Teaching Hospital is located in Oghara, Ethiope West Local Government and is the only teaching Hospital in Delta State. It is accredited to Delta State University for the training of medical students and also trains resident doctors in 18 specialties. It renders tertiary health care services to mostly the southern part of Delta State. Delta State University Teaching Hospital has 1,118 permanent staff. The hospital operates a Contributory Health Insurance scheme for all the permanent staff. The scheme offers investigations and treatment for commons ailments to all staff. The investigation includes malaria parasite, Widal test, urinalysis, heamoglobin, stool microscopy, urine microscopy, pregnancy test, and blood sugar test. Other investigations at secondary level of care include urea and electrolyte, bilirubin (total and conjugated), microscopy, culture and sensitivity of body fluids, liver function test, chest X-ray, abdominopelvic scan, and obstetric scan.

The study population were clinical and non-clinical staff of Delta State University Teaching Hospital. The clinical staff comprised doctors, nurses, pharmacists, and other allied health workers, whereas the non-clinical staff comprised administrative staff, biomedical technicians, Information Communication Technology, cleaners, and account staff. All permanent staff who gave informed consent were recruited for the study, whereas temporary staff on internship or industrial attachment and staff who did not give their informed consent were excluded from the study.

The sample size for the study was determined using the Yamane's formula[15];

n = N/1 + N (e)

Where n = sample size

N = population size

e = level of precision (0.05)

= 295

A two-stage sampling technique was used for the study; in the first stage, the total number of staffs within the different departments (both clinical and non-clinical) in the hospital was compiled and a proportionate number within each department was determined. The second stage involved simple random selection of participants within each department until the sample size was gotten.

A semi-structured questionnaire was designed and distributed among the staff within the departments of the hospital that consented to participate in the study by agreeing to complete the questionnaire. The questionnaire was structured into five parts, namely, sociodemographic characteristics of the respondents, knowledge, perception, and practice of routine medical screening. The fifth section was on factors affecting the practice of routine medical screening among the respondents.

Data analysis

All collected data were entered into the spread sheet of Statistical Package for Social Science (SPSS) version 22 (IBM Corp; Armonk NY, USA) for analysis. Descriptive statistics were presented as frequencies, percentage, and means. Chi square was used to assess the test of significance between categorical variables. A P value of less than 0.05 was considered statistically significant Knowledge, perception, and practice of routine medical screening were assessed using a scoring system. Knowledge scale had a 16-point scoring: 0–8 points was considered poor, 9–12 points was fair, whereas >12 was good. Perception had a 10-point scoring system; ≤7 was poor, whereas >7 was good. Practice of routine medical screening had a 15-point scoring; ≤11 was poor, whereas >11 points was good.

Ethical approval for the study was obtained from the Health and Research Ethics committee of Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.


   Results Top


Socio-demographic characteristics

A total of 297 participants completed their questionnaires out of 320 distributed given a responses rate of 92.8%. The socio-demographic characteristics of the respondents are represented in [Table 1]. The mean age was 35.04 ± 12.69 years, the largest age range was 30–34 (27.90%) years, and median of 32 years. They were more female respondents 53.20%, than male 46.80%. Most of the respondents were married 152 (51.1%).
Table 1: Sociodemographic characteristics of respondents

Click here to view


Most of the respondents 276 (92.9%) were Christians, 11 (3.70%) were Muslims, and 10 (3.37%) respondents practiced the African Traditional Religion.

Most of the respondents are educated up to tertiary level (77.44%). The distribution of the participants shows that 25.5% were nurses, 18.8% were doctors, and 16.4% were administrative staff. A breakdown of the distribution within the clinical and non-clinical staffs is shown in [Table 1].

Knowledge of routine medical screening

The general knowledge about routine medical screening is shown in [Table 2]. Majority (84.5%) of the respondents had heard about routine medical screening and the biggest source of information was from health personnel at work (41.10%). A list of what respondents consider to make up routine medical screening is shown in [Table 2]. Blood pressure check (80.0%), followed by fasting blood sugar check (74.4%), and HIV screening (61.6%) were the most common types of routine medical screening known by the respondents. Most of the respondents (30.30%) believe routine medical screening should be done yearly, whereas 19.50% of respondents believed that the frequency would depend on what one would be screening for and 19.2% indicated that they did not know the interval.
Table 2: General Knowledge on routine medical screening

Click here to view


Among the respondents, knowledge score was good in 58.3%, fair in 25.1%, and poor in 25.1%.

Perception of respondents to routine medical screening

The respondents' perception to routine medical screening is presented in [Table 3]. Most of the staff, 278 (93.6%) thought routine medical screening was important, 68.0% believe the main advantage of routine medical screening is early detection of disease, whereas 12.10% believe it is to prevent disease from occurring. Majority of respondents feel that health checks should be mandatory (72.10%) as opposed to 27.90% who disagree. However, 69.70% of respondents think the management of the hospital and the government should bear the cost of routine medical screening for the staff, whereas 17.20% believe the individual health workers should bear the cost themselves.
Table 3: Perception towards routine medical screening

Click here to view


The perception score among the respondents was good in 187 (62.3%) and poor in 110 (37.3%).

Practice of routine medical screening

The information on the practice of the respondents to routine medical screening is represented in [Table 4]. Within the different categories of health professionals, most of the doctors 18 (32.1%) had not done any routine screening in more than 5 years followed by doctors who have done their routine medical screening within a year 15 (26.7%). About 30 (39.4%) of the nurses had their routine medical screening within a year at the time of this research followed by those who had their screening between one year and less than two years 17 (22.3%). Other allied staff had most of their routine screening between one year and less than two year 19 (39.5%) followed by more than five years 11 (22.3%), whereas administrative staff had the highest proportion of routine medical screening within one year 22 (44.8%). Among the other non-clinical staff, the highest proportion 35 (55.3%) had their routine medical screening within a year of the time of the research followed by those that did their screening between a year and less than two years 12 (17.6%).
Table 4: Practice of Routine medical Screening

Click here to view


Comparing those who did their routine medical screening within a year to those who have done their routine screening more than a year, more doctors and nurses had their last routine medical screening more than a year compared to the administrative staff and other nonclinical staff who had their routine medical screening within the past one year. This was statistically significant chi square χ2 = 13.4, P = 0.004.

Fasting blood sugar 179 (60.2%) was the commonest test done followed by fasting blood sugar 141 (47.4%). About 5.0% among the male respondents did Prostatic Surface Antigen (PSA).

The main reasons for not doing a comprehensive routine medical screening in the last one year were attributed to cost of tests 108 (36.4%) followed by forgetting to do the tests 42 (14.1), being well and so not needing to screen 33 (11.1%). Other reasons are represented in [Table 4]. Among the respondents who have done any form of medical test, 96 (32.3%) did the test between 1 and 3 months and 66 (22.2%) did the test between 7 and 12 months. The main reasons for doing a medical test in the past one year were mainly because of illness or not feeling well 147 (60.0%), followed by “as routine medical checkup” 63 (25.4%), then as pre-employment medical screening 20 (8.0%).

The practice of routine medical screening score was good in 78 (26.2%) and poor in 219 (73.7%). The chi square analysis of socio-demographic factors and practice score is seen in [Table 5]. There was no statistical significance between age, marital status, and category of health worker. However, there was statistically significant association between sex and practice of routine medical screening, female had better practice of routine medical screening compared to men, P = 0.004.
Table 5: Factors influencing the practice of routine medical screening

Click here to view


Factors affecting the practice of routine medical screening

Factors affecting the practice of routine medical screening are represented in [Table 5]. It showed that the main factors that affected uptake of routine medical screening were sex, being managed for a medical condition, and cost of the medical screening (P = 0.04, P < 0.00, and P = 0.04, respectively).


   Discussion Top


This study sought to know the knowledge, practice, and factors affecting the practice of routine medical screening among staffs in Delta State University Teaching Hospital, Delta State, Nigeria.

Most of the respondents were between 30 and 34 years, this is similar to the study done among health workers in Ekiti, Sokoto, and Edo State.[14],[16],[17] In this study, females were slightly more represented than males. This is similar to the study by Branney and Newell[8] who believed that the higher number of female representation was because of the fact that nurses constituted the largest proportion of respondents, a profession dominated in most cases by females and this is likely the case in this study. However, similar studies conducted in Sokoto, Nigeria and in Hong Kong, China showed slightly less female representation than males.[16],[18]

Majority of the respondents in this study were aware of routine medical screening and this is not surprising because the study was carried out in a health facility and most of the respondents had tertiary level of education. This is quite similar to findings in another study in Ekiti State, South-West Nigeria where all their responders were aware of routine medical screening for similar reasons[18] and in other studies.[19],[20] The largest source of information to our responders were from health personnel at the work place, accounting for good dissemination of information about routine medical screening.

Most of the respondents in this study believe that routine medical screening should be done yearly unlike in other previous studies where an overwhelming majority of respondents believe that routine medical checkup should be done every 6 months.[21],[22] The yearly routine medical screening proposed by most of our respondents could be as a result of the information they would have gotten from health talk or enlightenment campaigns from other health personnel at work.

Blood pressure check and fasting blood sugar check were the commonest types of routine medical screening known by the respondents. This is similar to studies done in other parts of the country.[14],[16],[18],[19],[20],[21] The commonest non-communicable diseases in Nigeria are currently hypertension and diabetes mellitus and this shows that there is a high level of awareness on the importance of regular blood pressure check and fasting blood sugar check among staff of the hospital. The knowledge score was good in 58.3% of the respondents that shows good knowledge on routine medical screening in more than half of the respondents and this could be because of wide dissemination of information on health-related matters to most of the staff of the hospital and the high level of education.

Most of the respondents think routine medical screening is important and the main reason was for early detection of diseases. This is similar to study done among health care workers in Ekiti, Sokoto, Edo, Cross River, and Lagos States.[14],[16],[18],[19],[20],[21],[23] A large proportion of the respondents felt routine medical screening should be mandatory and the cost should be borne by the hospital or the government. This may help improve the uptake of routine medical screening and the existence of Contributory Health Scheme by the hospital and government who are the employers will remove the burden of direct cost to the respondents. The perception score was good in more than half of the respondents that could be as a result of the high knowledge score.

Regardless of the high knowledge and perception on routine medical screening, a significant proportion of the doctors, nurses, and other allied health workers had not done their routine medical screening in more than one year, 2 years, and 5 years. This is similar to studies done in Ekiti and among family physicians by Peleg et al., where though the health workers had strong belief in doing routine medical screening, it did not translate to personal practice of routine medical screening.[14],[24] However, most the non-clinical staff had their routine medical screening within a year of the time of this research. This has highlighted what some studies have shown that health professionals both in other parts of the world and in Nigeria are at a higher risk of avoiding health-seeking behaviors because they can self-medicate, informally consult their colleagues when symptoms appear, the pressure of time, fear of showing weakness, or concerns about confidentiality.[8],[9],[10],[11],[12],[13],[14]

The major reasons cited by respondents for not doing the medical screening in the past one year was cost (36.4%) followed by forgetfulness (14.1%). It is quite important to note that the Contributory Health Scheme operated by the hospital covers most of the laboratory investigations and basic radiological investigations so these are free to the staff if accessed through the right channels. This is similar to findings from researchers in Cross Rivers State, Nigeria.[21] The main factors that influenced practice of routine medical screening were female gender and “being managed for a medical condition.” These were significantly associated with good practice of routine medical screening, whereas cost of routine medical screening was associated with poor practice. Most preventive health talks seem to focus more on female health conditions, such as breast and cervical cancer awareness than male diseases and these could have helped in improving the practice among the female gender. The study in Sokoto[16] and Lagos[23] which showed that a family history of a medical condition created a positive health-seeking behavior; however, being managed for a medical condition could also create a positive health-seeking behavior.


   Conclusion and Recommendation Top


The practice of routine medical screening by the health care workers in our region is poor despite the demonstration of a good knowledge of routine medical screening. The study also showed that the doctors, nurses, and other allied health workers had not accessed the routine medical screening within a year compared with the non-clinical workers. This study shows that the major factors affecting uptake of routine medical screening were sex, history of being managed for a health condition, and financial constraint.

The recommendations are that the clinical health workers should be given a specific work-free period of the year to come for their routine medical screening. It could be a rotatory basis so clinical activities would not be compromised. Written reminders should be given to defaulters and if necessary, it may be mandatory to all staff. Staff of the hospital should be better enlightened on the use and importance of the Contributory Health Scheme in routine medical screening.

The enlightenment campaigns should also target the male gender in promoting positive health-seeking behavior.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ilesanmi OS, Omotoso B, Alele F, Amenkhienan I. Periodic medical checkup: Knowledge and practice in a community in South West Nigeria. Int J Res Public Health 2015;5:576-83.  Back to cited text no. 1
    
2.
General Medical Examination. Available from: www.wikipedia.com. [Last accessed on 2021 Jul 23].  Back to cited text no. 2
    
3.
Culica D, Rohrer J, Ward M, Hilsenrath P, Pomrehn P. Medical checkups: Who does not get them? Am J Public Health 2002;92:88-91.  Back to cited text no. 3
    
4.
Sun X, Chen Y, Tong X, Feng Z, Wei L, Zhou D, et al. The use of annual physical examinations among the elderly in rural China: A cross-sectional study. BMC Health Serv Res 2014;14:16.  Back to cited text no. 4
    
5.
Morrison AS. Screening in Chronic Disease. 2nd ed. New York: Oxford University Press; 1992.  Back to cited text no. 5
    
6.
Eluf-Neto J. Rastreamentoem medicina interna. In: Martins MA, Carrilho FJ, Alves VAF, Castilho EA, Cerri GG, Wen CL, editors. Clínica Médica. Vol. 7. Barueri: Ed. Manole Ltd; 2009. p. 368-73.  Back to cited text no. 6
    
7.
Stewart-Brown S, Farmer A. Screening could seriously damage your health. BMJ 1997;314:533-4.  Back to cited text no. 7
    
8.
Branney J, Newell D. Back pain and associated healthcare seeking behavior in nurses. Clin Chiropr 2009;12:130-43.  Back to cited text no. 8
    
9.
Gonçalves-Silva AC, Murta-Nascimento C, Eluf-Neto J. Assessing screening practices among health care workers at a tertiary-care hospital in Sao Paulo, Brazil. Clinics (Sao Paulo) 2010;65:151-5.  Back to cited text no. 9
    
10.
Rennert M, Hagoel L, Epstein L, Shifroni G. The care of family physicians and their families: A study of health and help-seeking behaviour. Fam Pract 1990;7:96-9.  Back to cited text no. 10
    
11.
Furman S. A study of doctors health seeking behavior. Afr Fam Pract 1992;13:92-7.  Back to cited text no. 11
    
12.
Fawibe AE, Odegiah IO, Akande TM, Saludeen AG, Olanrewaju I. Self-reported medical care seeking behavior of doctors in Nigeria. Alexandria J Med 2017;53:117-22.  Back to cited text no. 12
    
13.
Bana S, Yakoob J, Jivany N, Faisal A, Jawed H, Awan S. Understanding health seeking behavior of health care professionals in tertiary care hospitals in Pakistan. J Ayub Med Coll Abbottabad. 2016;28:545-9.  Back to cited text no. 13
    
14.
Adewoye K, Aremu S, Ipinnimo T, Salawu I, Orewole T, Bakare A. Awareness and practice of proper health seeking behaviour and determinant of self-medication among physicians and nurses in a tertiary hospital in Southwest Nigeria. Open J Epidemiol 2019;9:36-49.  Back to cited text no. 14
    
15.
Yamane T. Statistics: An Introductory Analysis, 2Nd Edition, New York: Harpers and Row 1960: p. 886-7.  Back to cited text no. 15
    
16.
Adamu H, Yusuf A, Inalegwu CU, Sufi RA, Adamu AN. Factors influencing health-seeking behavior of health workers in a tertiary health institution in Sokoto, Northwest Nigeria. Sahel Med J 2018;21:162-70.  Back to cited text no. 16
  [Full text]  
17.
Oguntoye OO, Yusuf M, Durowade KA. Perception and practice of routine medical check-up by health workers at a tertiary health facility in South-West Nigeria. Int J Med Biomed Res 2017;6:151-62.  Back to cited text no. 17
    
18.
Chen JY, Tse EY, Lam TP, Li DK, Chao DV, Kwan CW, et al. Doctors' personal healthcare choices: A cross-sectional survey in a mixed public/private setting. BMC Public Health 2008;8:183.  Back to cited text no. 18
    
19.
Omokhua HA, Ehizele AO. Routine medical check among dental health workers in Edo State. Nig J Dent Res 2020;5:20-9.  Back to cited text no. 19
    
20.
Akande TM, Salaudeen AG. Practice of periodic medical examination among hospital workers in a Nigerian tertiary hospital. Nig Qt J Hosp Med 2004;14:206-10.  Back to cited text no. 20
    
21.
Ojong IN, Nsemo AD, Aji P. Routine medical checkup knowledge, attitude and practice among health care workers in a tertiary health facility in Calabar, Cross River State, Nigeria. Glob J Health Sci 2020;12:27-37.  Back to cited text no. 21
    
22.
Olayinka SI, Omotoso B, Alele F, Ibidun A. Periodic medical checkup: Knowledge and practice in a community in South West Nigeria. Int J Public Health 2015;5:576-83.  Back to cited text no. 22
    
23.
Lanre-Babalola FO. Routine medical checkups and preventive health knowledge among health professionals in LUTH, Idi Araba, Lagos state. Glob J Appl Manag Soc Sci 2014;7:82-8.  Back to cited text no. 23
    
24.
Peleg R, Ostermich A, Gienco V, Portughiez E. Screening tests among family doctors: Do we do as we preach? Public Health 2013;127:282-9.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    Conclusion and R...
    References
    Article Tables

 Article Access Statistics
    Viewed351    
    Printed16    
    Emailed0    
    PDF Downloaded52    
    Comments [Add]    

Recommend this journal