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Dance Gudeva Nikovska and Fimka Tozija


BACKGROUND: Stigma and discrimination are interrelated and are breaking the fundamental human rights. Both are associated with tuberculosis (TB) disease since ever and have negative influence on activities aimed at TB prevention, treatment and control, both at individual, community and societal level.

AIM: To determine the magnitude of TB stigma in Republic of Macedonia, identify root causes and detect main determinants associated with it.

MATERIAL AND METHODS: Cross-sectional study was performed on 315 TB patients registered in the period Jul, 2012-Jun, 2013, using selected module from World Health Survey questionnaire. Self-reported data is collected through face to face interview conducted by trained directly observed treatment (DOT) nurses in the patients’ home.

RESULTS: 16.7% TB patients have not received any assistance when diagnosed with TB and 8.4% were treated badly by a member of the family or close friends because of the disease, consequences ranging from living the patient completely, refusal to talk or telling other people that the person is infected. An odd for such behavior were higher if the patient is male, married, have no formal education or have completed only primary school, is unemployed and lives in rural area.

CONCLUSION: Understanding the origins of TB stigma is integral to reducing its impact on health. Our survey has provided a baseline on the magnitude of existent stigma associated with TB disease and has identified main determinants that trigger stigmatizing behavior.

Open access

Fimka Tozija and Nikola Jankulovski


The aim of this paper was to present the strategic approach applied for improvement of quality in emergency medical services (EMS) in the Republic of Macedonia. This approach was accomplished through three stages: (I) assessment and recommendations for policies; (II) development of innovative evidence-based programmes; and (III) policy implementation. Strategic assessment of EMS was performed by applying WHO standard methodology. A survey was conducted in 2006/2007 on the national level in fifteen general hospitals, four university hospitals, and sixteen pre-hospital EMS. The overall evaluation was based on a hospital emergency department (ED) questionnaire, information on the general characteristics of the pre-hospital dispatch centre, review of ED medical records, and the patient questionnaire. The key findings of the assessment showed that EMS required extensive changes and improvements. Pre-hospital EMS was not well-developed and utilised. Hospital EDs were not organised as separate divisions ran by a head medical doctor. The diagnostic and treatment capacities were insufficient or outdated. Most of the surveyed hospitals were capable of providing essential diagnostic tests in 24 h or less. There was no follow-up of the EMS patients or an appropriate link between the hospital EDs and primary health care facilities. The main findings of the assessment, recommendations, and proposals for action served as the basis for new policies and integrated into Macedonia’s official strategy for emergency medical services 2009-2017.

Open access

Dimitrinka Jordanova Peshevska, Marija Raleva, Izabela Filov, Dinesh Sethi, Tamara Jordanova, Kadri Hazdi Hamza, Fimka Tozija and Vesna Damchevska Ilievska


OBJECTIVES: One of the main objectives of this paper is to analyze the associations between physical abuse and neglect and health risk behaviours among young adolescents in the country.

METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6%), aged 18 and above. About 664 of them are in last (fourth) year of secondary school and 613 respondents are first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p<0.05.

RESULTS: Physical abuse (21.1%) and physical neglect (20%) were reported with similar prevalence rates. Disciplining children by spanking or corporal punishment was presented with very high rate of 72.4%.

CONCLUSION: The results demonstrated a relationship between physical abuse and later manifestation of health risk behaviours such as: smoking and early pregnancy. Physical neglect increased the chances for drug abuse, drink-driving, having early sex, having more sexual partners.