scholarly journals An assessment of nursing mothers’ and young people’s access to proprietary and patent medicine vendors’ services in rural communities of south-eastern Nigeria: implication for review of national drug policy

2021 ◽  
Vol 14 (S1) ◽  
Author(s):  
C. J. Uneke ◽  
I. Obeka ◽  
B. I. Uneke ◽  
A. Umeokonkwo ◽  
C. A. Nweze ◽  
...  
Keyword(s):  
Family Planning ◽  
Young People ◽  
Low Income ◽  
Healthcare Delivery ◽  
Access To Medicines ◽  
Health Coverage ◽  
Cross Sectional ◽  
South Eastern ◽  
Healthcare Needs ◽  
Nursing Mothers

Abstract Background Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage. Methods A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine. Results A total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8. Conclusion PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.

Pengaruh Pendapatan, Pengetahuan Dan Kerentanan Penyakit Terhadap Willingness To Pay (WTP) Premi Jaminan Kesehatan Pada Pekerja Sektor Informal

2021 ◽  
Vol 7 (1) ◽  
pp. 48-59
Author(s):  
Anom Dwi Prakoso
Keyword(s):  
Health Insurance ◽  
Willingness To Pay ◽  
Informal Sector ◽  
Low Income ◽  
Disease Susceptibility ◽  
Universal Coverage ◽  
Health Coverage ◽  
Cross Sectional ◽  
Susceptibility Data ◽  
Central Java

  Background: The Indonesian Government's target of Universal Coverage or 100% Health Insurance participation by 2019 failed to be achieved, even until the end of October 2020. The failure of universal coverage resulted in BPJS Health's finances getting worse after experiencing a deficit. Informal sector workers are the most dominant sector that has not participated in the Health Insurance scheme, totaling 30,487,891 workers. Low income, uncertainty each month, and the increase in contributions resulted in a decrease in Willingness to pay Health Insurance contributions. Research purposes: The purpose of this study is to analyze the effect of income, knowledge, and disease susceptibility to the willingness to pay (WTP) of health insurance contributions to informal sector workers. Method: This cross-sectional research was conducted in Kudus Regency, Central Java in January-February 2020. Sampling used purposive sampling with a total of 200 informal sector workers who had not yet participated in BPJS Kesehatan. The dependent variable is a willingness to pay. The independent variables are income, knowledge, and disease susceptibility. Data collection using a questionnaire and data analysis with logistic regression. Result: Willingness To Pay health insurance contributions for informal sector workers increased in income ≥Rp 2,218,451 (b = 2.02; 95% CI = 1.01-3.55; p = 0.044), high knowledge (b = 4.64; 95% CI = 2.36-8.31; p <0.001), high disease susceptibility (b = 3.01; 95% CI = 0.26-5.75; p = 0.031). Conclusion: Income, knowledge, and disease vulnerability have a significant effect on the willingness to pay for health insurance contributions for informal sector workers.   Keywords: Universal Health Coverage; Willingness To Pay; Health Insurance; informal sector workers.

scholarly journals Equity in access to non-communicable disease medicines: a cross-sectional study in Kenya

2018 ◽  
Vol 3 (3) ◽  
pp. e000828 ◽  
Author(s):  
Peter C Rockers ◽  
Richard O Laing ◽  
Veronika J Wirtz
Keyword(s):  
Health Facility ◽  
Universal Health Coverage ◽  
Access To Medicines ◽  
Household Wealth ◽  
Health Coverage ◽  
Cross Sectional ◽  
Household Asset ◽  
Equity In Access ◽  
The Relationship ◽  
Universal Health

IntroductionWealth-based inequity in access to medicines is an impediment to achieving universal health coverage in many low-income and middle-income countries. We explored the relationship between household wealth and access to medicines for non-communicable diseases (NCDs) in Kenya.MethodsWe administered a cross-sectional survey to a sample of patients prescribed medicines for hypertension, diabetes or asthma. Data were collected on medicines available in the home, including the location and cost of purchase. Household asset information was used to construct an indicator of wealth. We analysed the relationship between household wealth and various aspects of access, including the probability of having NCD medicines at home and price paid.ResultsAmong 639 patients interviewed, hypertension was the most prevalent NCD (69.6%), followed by diabetes (22.2%) and asthma (20.2%). There was a positive and statistically significant association between wealth and having medicines for patients with hypertension (p=0.020) and asthma (p=0.016), but not for diabetes (p=0.160). Poorer patients lived farther from their nearest health facility (p=0.050). There was no relationship between household wealth and the probability that the nearest public or non-profit health facility had key NCD medicines in stock, though less poor patients were significantly more likely to purchase medicines at better stocked private outlets. The relationship between wealth and median price paid for metformin by patients with diabetes was strongly u-shaped, with the middle quintile paying the lowest prices and the poorest and least poor paying higher prices. Patients with asthma in the poorest wealth quintile paid more for salbutamol than those in all other quintiles.ConclusionThe poorest in Kenya appear to face increased barriers to accessing NCD medicines as compared with the less poor. To achieve universal health coverage, the country will need to consider pro-poor policies for improving equity in access.

scholarly journals Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e024991 ◽  
Author(s):  
Timothy David Noblet ◽  
John F Marriott ◽  
Taryn Jones ◽  
Catherine Dean ◽  
Alison B Rushton
Keyword(s):  
Absolute Risk ◽  
Healthcare Delivery ◽  
Health Sector ◽  
Geographical Location ◽  
Cost Benefit ◽  
Access To Medicines ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Australian Health ◽  
Descriptive Survey

ObjectivesTo explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide.DesignA cross-sectional descriptive survey using open and closed questions.SettingParticipants completed an online questionnaire.Participants883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories.Outcome measuresAn online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data.Results79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs.ConclusionsAHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost–benefit and risk analysis when planning the introduction of physiotherapist prescribing.

scholarly journals Establishment of a high-dependency unit in Malawi

2020 ◽  
Vol 5 (11) ◽  
pp. e004041
Author(s):  
Ben Morton ◽  
Ndaziona Peter Banda ◽  
Edna Nsomba ◽  
Clara Ngoliwa ◽  
Sandra Antoine ◽  
...  
Keyword(s):  
Low Income ◽  
Healthcare Delivery ◽  
Physical Space ◽  
Treatment Modalities ◽  
Organ Support ◽  
High Dependency Unit ◽  
Tertiary Referral Centre ◽  
Healthcare Needs ◽  
High Dependency ◽  
Sub Saharan

Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.

scholarly journals Implementation of Adolescent and Youth Friendly Health Services in a Rural Region of Tigray, Ethiopia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Cigliano ◽  
H Gebremichael ◽  
K Teklay ◽  
B Ayele ◽  
D Negash ◽  
...  
Keyword(s):  
Family Planning ◽  
Young People ◽  
Health Services ◽  
Sex Education ◽  
Low Income ◽  
Public Health Problem ◽  
Health Centers ◽  
Low Income Countries ◽  
Sexual Life ◽  
Youth Friendly

Abstract Background The Eastern Zone of the Tigray (Ethiopia) is inhabited by 900,000 people, 34% of whom are adolescents and young people between 10-24 years of age, who are easily influenced by the social and family context and are exposed to significant health risks associated with the earliness of their approach to sexual life. Nonetheless, even if a complete health service is available, the quality is often undermined by the lack of the so-called Youth-Friendly Corners (high confidentiality spaces reserved for young people), promoted internationally by WHO. The aim of the study is to evaluate the effectiveness of the program established in this zone by the Medical Collaboration Committee regarding the creation of friendly health services for adolescent and youth people (AYFHS), especially built for sex education, family planning, abortion, and sexual transmitted infection (STI) prevention. Methods The program “#Youths at the centre!” was implemented in 20 rural health centers in the North-East Tigray on April 2018. Data from these AYFHS were collected monthly in aggregated indicators, separated for gender and age class. Use of AYFHS during 2018 and 2019 was assessed using percentage and 95% confidence interval and the period of implementation of the project and centers' characteristics were analyzed to investigate differences in AYFHS utilization. Results A monthly mean of 6.04% (6.01% - 6.08%) of adolescents and young people utilized an AYHFS for any of its service; 0.03% accessed for counseling, diagnosis, and treatment of STI, 1.31% for family planning, 1.09% for delivery, and 0.05% for legal abortion. Lower level of utilization was observed in more remote health centers, despite a general increase across the study period. Conclusions This project shows the importance of providing friendly facilities dedicated to adolescents and youth in low-income countries, in order to increment the utilization of health services from this population, especially in rural contexts. Key messages In rural areas of Africa the risks associated with poor health information of young people and the earliness of the beginning of sexual life remain a Public Health problem. In low income countries the presence of high confidentially spaces for young people in the Health Services could increase their utilization, especially for sex education and family planning.

scholarly journals Regulatory compliance among over-the-counter medicine sellers facilities within the Upper East Region of Ghana

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Benjamin Kwarteng Frempong ◽  
Anthony Amalba ◽  
Nina Donkor ◽  
Kwadwo Owusu Akuffo
Keyword(s):  
Healthcare Delivery ◽  
Access To Medicines ◽  
Regulatory Compliance ◽  
Sub Saharan Africa ◽  
Easy Access ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Over The Counter ◽  
East Region ◽  
Upper East Region

Abstract Background Easy access to medicines provided by private medicine retailing facilities including that of over-the-counter medicine retailers, have gained prominence in sub-Saharan Africa. Although over-the-counter medicine-sellers (OTCMS) facilities play an indispensable role in healthcare delivery, there is inadequate information about their regulatory environment and whether their operations conform to regulatory provisions. Hence, this study sought to investigate the characteristics and predictors of regulatory practices among over-the-counter medicine sellers in Ghana. Methods This was a cross-sectional study involving participants from 208 OTCMS facilities in eight (8) municipalities and districts (MDA’s) of the Upper East Region of Ghana. An initial census of facilities in the region was conducted between May and August 2016 and a follow-up conducted between December 2016 and March 2017. This ensured the identification and location of all OTCMS facilities within the selected MDA’s for study planning and data collection. The main outcome variable was regulatory compliance which is a composite of three indicators for regulatory practices (retention of medicine supplier’s invoices and receipts on-premises), licensing and registration requirements (appropriate signage), and equipment and material requirements (availability of reference material). Regulatory compliance was assessed using bivariate and multivariate logistic regression analyses. Results In this survey, 21.5%, 38.2%, and 23.1% of the facilities surveyed had a good state of repair, had the owner of the facility available on the premises, and had received regulatory visit(s) in less than 12 months, respectively. Only 29.2% of facilities were regulatory compliant. After statistical adjustment, OTCMS facility location (compared with Rural: Urban, AOR = 4.2, 95% CI 1.74–10.17, p = 0.001) and staff trained in less than 1 year (AOR = 2.78, 95% CI 1.02–7.62, p = 0.046) were significantly associated with regulatory compliance. Conclusions Regulatory compliance was low in the Upper East Region of Ghana, particularly across rural locations, where most of the facilities failed to meet the laid down provisions of the Pharmacy Council regarding practice, staff and premises requirements. This could be attributed to the fact that these areas are poorly resourced. Policymakers are been called on to put in place pragmatic measures in relation to OTCMS facility’s location and regulatory requirements to address the inequities in compliance.

Number of Daily Steps to Discriminate Abdominal Obesity in a Sample of Brazilian Children and Adolescents

2017 ◽  
Vol 29 (1) ◽  
pp. 121-130 ◽  
Author(s):  
Alex Pinheiro Gordia ◽  
Teresa Maria Bianchini de Quadros ◽  
Jorge Mota ◽  
Luciana Rodrigues Silva
Keyword(s):  
Young People ◽  
Abdominal Obesity ◽  
Low Income ◽  
Weight Status ◽  
Area Under The Curve ◽  
Cross Sectional Study ◽  
Step Count ◽  
Northeastern Brazil ◽  
Low Income Countries ◽  
Cross Sectional

Purpose:Weight status-referenced pedometer step-count guidelines for young people have been developed for populations from high-income countries and may not be applicable to middle- and low-income countries. The objectives of this study were 1) to develop cut-off points for pedometer-determined step count in young Brazilians using waist circumference (WC) as a reference criterion, and 2) to analyze the capacity of previous recommendations to discriminate abdominal obesity in the sample studied.Methods:A cross-sectional study was conducted on 1,044 schoolchildren (456 boys) aged 6–17 years from Northeastern Brazil. WC was measured and daily step counts were determined with a pedometer.Results:The area under the curve (AUC) of step count was significant for boys (AUC = 0.55; 95%CI: 0.50–0.59) and girls (AUC = 0.57; 95%CI: 0.53–0.61). Our cut-off points (14,414 and 11,355 steps for boys and girls, respectively) were more balanced in terms of sensitivity and specificity compared with previous recommendations. The use of previous guidelines to classify step count in the sample provided very low sensitivity or specificity and wide variation in the prevalence of insufficient physical activity (39.3–77.0%).Conclusions:A universal step-count recommendation for young people may not be adequate and specific guidelines seem to be necessary for different countries or regions.

scholarly journals Interpreting the Lancet surgical indicators in Somaliland: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042968
Author(s):  
Shukri Dahir ◽  
Cesia F Cotache-Condor ◽  
Tessa Concepcion ◽  
Mubarak Mohamed ◽  
Dan Poenaru ◽  
...  
Keyword(s):  
Low Income ◽  
Assessment Tool ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Current Status ◽  
Health Coverage ◽  
Surgical Volume ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Workforce

BackgroundThe unmet burden of surgical care is high in low-income and middle-income countries. The Lancet Commission on Global Surgery (LCoGS) proposed six indicators to guide the development of national plans for improving and monitoring access to essential surgical care. This study aimed to characterise the Somaliland surgical health system according to the LCoGS indicators and provide recommendations for next-step interventions.MethodsIn this cross-sectional nationwide study, the WHO’s Surgical Assessment Tool–Hospital Walkthrough and geographical mapping were used for data collection at 15 surgically capable hospitals. LCoGS indicators for preparedness was defined as access to timely surgery and specialist surgical workforce density (surgeons, anaesthesiologists and obstetricians/SAO), delivery was defined as surgical volume, and impact was defined as protection against impoverishment and catastrophic expenditure. Indicators were compared with the LCoGS goals and were stratified by region.ResultsThe healthcare system in Somaliland does not meet any of the six LCoGS targets for preparedness, delivery or impact. We estimate that only 19% of the population has timely access to essential surgery, less than the LCoGS goal of 80% coverage. The number of specialist SAO providers is 0.8 per 100 000, compared with an LCoGS goal of 20 SAO per 100 000. Surgical volume is 368 procedures per 100 000 people, while the LCoGS goal is 5000 procedures per 100 000. Protection against impoverishing expenditures was only 18% and against catastrophic expenditures 1%, both far below the LCoGS goal of 100% protection.ConclusionWe found several gaps in the surgical system in Somaliland using the LCoGS indicators and target goals. These metrics provide a broad view of current status and gaps in surgical care, and can be used as benchmarks of progress towards universal health coverage for the provision of safe, affordable, and timely surgical, obstetric and anaesthesia care in Somaliland.

scholarly journals Pengetahuan dan Pendapatan Akseptor KB dengan Penggunaan Alat Kontrasepsi Bawah Kulit (AKBK)

2020 ◽  
Vol 2 (1) ◽  
pp. 54-63
Author(s):  
Lia Hartini
Keyword(s):  
Family Planning ◽  
Low Income ◽  
Univariate Analysis ◽  
Survey Method ◽  
Test Results ◽  
Chi Square ◽  
Cross Sectional ◽  
Urban Village ◽  
Low Income Mothers ◽  
The Relationship

  This study aimed to determine the relationship between knowledge and income of family planning acceptors and subcutaneous contraception (AKBK) at BPM Habibah, Meat Jaya Village, in 2020. The research method used an analytic survey method with a Cross-Sectional approach. Univariate analysis results obtained from 50 respondents known that most respondents with good knowledge as many as 28 respondents (56%) more than those who lack awareness that is as much as 22 respondents (44%), a small proportion of respondents who have high incomes are 19 respondents (38%) more few of the low-income mothers were 32 respondents (62%). Those using under-skin contraception (AKBK) were 35 (70%) respondents. Based on the chi-square statistical test results on the relationship between knowledge (ρ value 0.011) and income (ρ value 0.042) with the use of AKBK. In conclusion, there is a significant relationship between knowledge and income with the use of under-the-skin contraception (AKBK) at BPM Habiba, Meat Jaya Urban Village, in 2020.  Keywords: Family Planning Acceptor, Knowledge Contraception, Income

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