scholarly journals Health service utilisation lags behind maternal diseases or illnesses during pregnancy in rural south Ethiopia: A prospective cohort study

2019 ◽  
Author(s):  
Moges Tadesse ◽  
Eskindir Loha ◽  
Kjell Arne Johansson ◽  
Bernt Lindtjørn
Keyword(s):  
Cohort Study ◽  
Health Service ◽  
Pregnant Women ◽  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Health Service Utilisation ◽  
Southern Ethiopia ◽  
Service Utilisation ◽  
Health Institution

AbstractMaternal survival has improved substantially in the last decades, but evidence on maternal morbidity and health service utilisation for various maternal diseases are scarce in low resource settings. We aimed to measure health service utilisation for maternal illnesses during pregnancy. A cohort study of 794 pregnant women in rural southern Ethiopia was carried-out from May 2017 to July 2018. Disease or illness identification criteria were: symptoms, signs, physical examination, and screening of anaemia. Follow-up was done every two weeks. Data on health service utilisation was obtained from women and confirmed by visiting the health facility. Multilevel, multiple responses, repeated measures, and generalized linear mixed model analysis were used. The cumulative incidence of women experiencing illness episodes was 91%, and there were 1.7 episodes of diseases or illnesses per woman. About 22% of pregnant women were anaemic and 8% hypertensive. Fourteen pregnant women experienced abortions, 6 had vaginal bleeding, 48% pain in the pelvic area, 4% oedema, and 72% tiredness. However, health service utilisation was only 7%. About 94% of anaemic women did not get iron-folic-acid tablet supplementation. Only two mothers with blurred vision and severe headache were referred for further treatment. The main reasons for not using the health services were: the perception that symptoms would heal by themselves (47%), illness to be minor (42%), financial constraints (10%), and lack of trust in health institutions (1%). Risk factors were being older women, poor, having a history of abortion, living far away from the health institution, travelled longer time to reach a health institution, and monthly household expenditure >=30 USD. In Conclusion, there was a high incidence of diseases or illnesses; however health service utilisation was low. Poor understanding of severe and non-severe symptoms was an important reason for low health service utilisation. Therefore, community-based maternal diseases or illness survey could help for early detection. Ministry of Health should promote health education that encourages women to seek appropriate and timely care.

Health service utilisation by pregnant women over a seven-year period

Midwifery ◽  
2011 ◽  
Vol 27 (4) ◽  
pp. 474-476 ◽  
Author(s):  
David Sibbritt ◽  
Jon Adams ◽  
Chi-Wai Lui
Keyword(s):  
Health Service ◽  
Pregnant Women ◽  
Health Service Utilisation ◽  
Service Utilisation

scholarly journals The epidemiology of multimorbidity in primary care: a retrospective cohort study

2018 ◽  
Vol 68 (669) ◽  
pp. e245-e251 ◽  
Author(s):  
Anna Cassell ◽  
Duncan Edwards ◽  
Amelia Harshfield ◽  
Kirsty Rhodes ◽  
James Brimicombe ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cohort Study ◽  
Health Service ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Lower Socioeconomic Status ◽  
Long Term Conditions ◽  
Lower Socioeconomic

BackgroundMultimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.AimTo describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.Design and settingRetrospective cohort study, undertaken in England.MethodThe study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.ResultsIn total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.ConclusionMultimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

scholarly journals Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiwot Abera Areru ◽  
Mesay Hailu Dangisso ◽  
Bernt Lindtjørn
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Southern Ethiopia ◽  
Service Utilisation ◽  
Cross Sectional ◽  
Health Authorities ◽  
Utilisation Rate ◽  
Children Under 5

Abstract Background Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities’ suggestions to improve the services. No study has assessed this in Ethiopia previously. Methods An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases’ diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. Result A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18–0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08–0.09). Children in the age group of 5–14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21–0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09–4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals’ skill and attitudes, and improving affordability and physical accessibility of the services. Conclusion The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

scholarly journals Longitudinal Youth in Transition Study (LYiTS): protocol for a multicentre prospective cohort study of youth transitioning out of child and adolescent mental health services at age 18

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e035744 ◽  
Author(s):  
Kristin Cleverley ◽  
Kathryn J Bennett ◽  
Sarah Brennenstuhl ◽  
Amy Cheung ◽  
Joanna Henderson ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Psychiatric Symptoms ◽  
Child And Adolescent ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Transition Study

IntroductionTransition between health services is widely recognised as a problematic hurdle. Yet, the factors necessary for successful transition out of child and adolescent mental health services (CAMHS) as youth reach the service boundary at age 18 are poorly understood. Further, fragmentation and variability among the services provided by mental health organisations serve to exacerbate mental illness and create unnecessary challenges for youth and their families. The primary aim of the Longitudinal Youth in Transition Study (LYiTS) is to describe and model changes in psychiatric symptoms, functioning and health service utilisation at the transition out of CAMHS at age 18 and to identify key elements of the transition process that are amendable to interventions aimed at ensuring continuity of care.Methods and analysisA prospective longitudinal cohort study will be conducted to examine the association between psychiatric symptoms, functioning and mental health and health service use of youth aged 16–18 as they transition out of child mental health services at age 18. We will recruit a sample of (n=350) participants from child and adolescent psychiatric programmes at two hospital and two community mental health sites and conduct assessments annually for 3 years using standardised measures of psychiatric symptoms, functioning and health service utilisation.Ethics and disseminationEthics approval has been obtained at all four recruitment sites. We will disseminate the results through conferences, open access publications and webinars.

Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter?

2019 ◽  
Vol 24 (2) ◽  
pp. 200-208
Author(s):  
Ravindra Arya ◽  
Francesco T. Mangano ◽  
Paul S. Horn ◽  
Sabrina K. Kaul ◽  
Serena K. Kaul ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Hippocampal Sclerosis ◽  
Brain Mri ◽  
Temporal Lobectomy ◽  
Seizure Freedom ◽  
Seizure Onset

OBJECTIVEThere is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy.METHODSChildren who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates.RESULTSOne hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2–8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis.CONCLUSIONSA lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.

scholarly journals Health literacy and age-related health-care utilisation: a multi-dimensional approach

2020 ◽  
pp. 1-22
Author(s):  
Joachim Gerich ◽  
Robert Moosbrugger ◽  
Christoph Heigl
Keyword(s):  
Health Literacy ◽  
Health Service ◽  
Health Care Utilisation ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Significant Interaction Effect ◽  
Medication Costs ◽  
Age Related ◽  
Care Utilisation ◽  
Health Related

Abstract Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals’ HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups.

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