scholarly journals Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241553
Author(s):  
Paul Truche ◽  
Rachel E. NeMoyer ◽  
Sara Patiño-Franco ◽  
Juan P. Herrera-Escobar ◽  
Myerlandi Torres ◽  
...  
Keyword(s):  
Surgical Care ◽  
Healthcare Facility ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Publicly Funded ◽  
Cross Sectional ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Timely Access ◽  
Surgical Conditions

Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.

scholarly journals Strategizing Public Sector Hospitals In Megacity Karachi: A Case Study On Gender Based Healthcare Facility Selection Criteria And Concerns (From Demand And Supply Perspective)

2019 ◽  
Vol 19 (1) ◽  
pp. 179-196
Author(s):  
Shamaila Burney ◽  
Khalid Mahmood Iraqi
Keyword(s):  
Public Sector ◽  
Selection Criteria ◽  
Healthcare Facility ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Demand And Supply ◽  
Healthcare Facilities ◽  
The Public

Karachi is the most populous city in Pakistan and it plays an important role in urban demography of Pakistan. It is growing rapidly, as every fifth urban citizen lives here. This urbanization creates serious challenges for all sectors of Karachi. Especially the health sector, from demand and supply view point is facing serious challenges in terms of non-availability of qualified doctors, specifically female doctors, medicines, latest equipment, poor infrastructure, and patient’s queues belonging to other rural areas because of the lack of quality healthcare facilities, makes the public hospitals crowded and overburdened. Like all over Pakistan, public sector hospitals are very much neglected in Karachi also and needs special consideration. The focus should be on developing patient oriented supply chains for efficient patient’s care and healthcare facilities. Moreover, the case study of Qatar hospital a part of our basic research study also highlighted the depriving condition for women patients’ in Emergency Department, because only male doctors are there but female doctors are not available. Although we observed that the gender wise daily patient flow was consist of 65% females, whereas only 35% male patients. The study suggests that there is an urgent need of women doctors and paramedics staff in the public sector hospitals of suburbs of Karachi. This paper presents a synoptic view of concerns of the residents of Karachi, and identification of their selection criteria of health care facilities. The study also aimed to provide solutions and recommendations for the improvement of these facilities. Cross sectional questionnaire and random sampling with two stage clusters sampling was used to record the responses of 1991 households, 46% respondents were female and 54% were male. Among the total of 11127 respondents, only 580, (5.2 %) sought treatment in public health hospitals and, 2440 (21.9 %) visited private hospitals. Research results shows that Cost is the only significant factor because of which people opt for treatment at public healthcare facility.

scholarly journals Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey

2021 ◽  
Vol 33 (2) ◽  
pp. 73-81
Author(s):  
Carlos Varela ◽  
Asgaut Viste ◽  
Sven Young ◽  
Reinou S. Groen ◽  
Leonard Banza ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Traffic Accidents ◽  
Surgical Care ◽  
Household Survey ◽  
Nationwide Survey ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Conditions ◽  
Surgical Condition

BackgroundUntreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need.AimTo estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries.MethodsA cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. ResultsThere were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. ConclusionAn extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.

scholarly journals Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Carlos Varela ◽  
Sven Young ◽  
Reinou S. Groen ◽  
Leonard Banza ◽  
Nyengo Mkandawire ◽  
...  
Keyword(s):  
Health Care ◽  
Health Facility ◽  
Scale Up ◽  
Surgical Care ◽  
Household Survey ◽  
Abdominal Distension ◽  
African Countries ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Conditions

Abstract Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.

scholarly journals Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey

2021 ◽  
Vol 18 (10) ◽  
pp. 5409
Author(s):  
Keiji Mochida ◽  
Daisuke Nonaka ◽  
Jason Wamulume ◽  
Jun Kobayashi
Keyword(s):  
Human Resources ◽  
Household Survey ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Public Healthcare ◽  
Supply Side ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Rural Zambia ◽  
The Village

Child mortality due to malaria and diarrhea can be reduced if proper treatment is received timely at healthcare facilities, but various factors hinder this. The present study assessed the associations between the use of public healthcare facilities among febrile/diarrheal children in rural Zambia and supply-side factors (i.e., the distance from the village to the nearest facility and the availability of essential human resources and medical equipment at the facility). Data from the Demographic and Health Survey 2018 and the Health Facility Census 2017 were linked. Generalized linear mixed models were used to assess the associations, controlling for clustering and other variables. The median distances to the nearest facility were 4.5 km among 854 febrile children and 4.6 km among 813 diarrheal children. Children who were over 10 km away from the facility were significantly less likely to use it, compared to those within 5 km (fever group: odds ratio (OR) = 0.37, 95% confidence interval (CI) = 0.21–0.68; diarrhea group: OR = 0.32, 95% CI = 0.20–0.50). The availability of human resources and equipment was, however, not significantly associated with facility use. Poor geographic access could be a critical barrier to facility use among children in rural Zambia.

Assessment of Healthcare Service Quality

2020 ◽  
pp. 271-291
Author(s):  
Segufta Dilshad ◽  
Afsana Akhtar ◽  
S. S. M. Sadrul Huda ◽  
Nandeeta Samad
Keyword(s):  
Service Quality ◽  
Quality Measurement ◽  
Healthcare Services ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Research Approach ◽  
Healthcare Facilities ◽  
Level Of Satisfaction ◽  
Related Quality ◽  
Private And Public

The service quality measurement of healthcare services is always a big concern for the hospitals, patient rights activists, regulators, and general patients. This study deals with quality assessment of healthcare facilities concerning the private and public health facilities of Dhaka, Bangladesh. This study follows the survey research approach. Using the purposive sampling method, the individuals have been selected from households who have received healthcare services from public or private hospitals of Dhaka city in last year. The study collected data among 410 respondents. Standard statistical software (i.e., SPSS and STATA) have been used to analyze the data. This study confirms existing evidence that Bangladeshi patients have a growing concern with lower level of satisfaction in public healthcare services. The respondents faced multi-dimensional problems, characterized by a low level of overall service quality, interpersonal service quality, and technical or treatment-related quality at public hospitals. Further research is recommended to analyze the issues further.

Management of public healthcare facilities in the Philippines: issues and concerns

2019 ◽  
Vol 25 (10) ◽  
pp. 1-17 ◽  
Author(s):  
Ramiro Z Dela Cruz ◽  
Ruth A Ortega-Dela Cruz
Keyword(s):  
Healthcare Delivery ◽  
Healthcare Services ◽  
The Philippines ◽  
Public Hospitals ◽  
Public Health Care ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Descriptive Research ◽  
Primary Means ◽  
Insufficient Knowledge

Background/Aims Public hospitals are the primary means of healthcare delivery in developing countries. Given the pressing need for efficient health services, it is imperative to know the extent to which a country's public healthcare institutions meet an ever increasing public demand. This study aimed to assess the state of hospital facilities among public health care institutions in a developing country. Methods Descriptive research methods were used, including needs analysis along with management and client satisfaction surveys, in order to analyse information on issues that related to the management of hospital facilities in the Philippines. Various members of the hospital community were selected to assess different aspects of hospital management. Results The results of this study show that most concerns stemmed from the lack of financial resources, materials, equipment and technological innovations; insufficient knowledge, skills and human resources; and problems that related to processes and methodologies. Conclusions Public hospitals are in dire need of facility upkeep to maintain their operations. This has become a more pressing concern because of the very limited resources at the disposal of public hospitals. This study also highlighted the crucial role played by the national government in finding effective and efficient ways to address these issues and concerns to ensure successful delivery of healthcare services in the country.

scholarly journals Exploring the influencing factors for non-utilisation of healthcare facilities during childbirth: a special mixed-method study of Bangladesh and 13 other low- and middle-income countries based on Demographic and Health Survey data

2019 ◽  
Vol 7 (4) ◽  
pp. e000008
Author(s):  
Tanjim Siddiquee ◽  
Henry Ratul Halder ◽  
Md Akhtarul Islam
Keyword(s):  
Birth Order ◽  
Health Survey ◽  
Mixed Method ◽  
Demographic And Health Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Significant Factors ◽  
Low And Middle Income

ObjectiveTo identify the associated factors affecting the decision regarding institutional delivery for pregnant women in 14 low- and middle-income countries (LMICs).DesignA special mixed-method design was used to combine cross-sectional studies for harmonising data from Bangladesh and 13 other countries to obtain extended viewpoints on non-utilisation of institutional healthcare facilities during childbirth.SettingDemographic and Health Survey (DHS) data for 14 LMICs were used for the study.ParticipantsThere are several kinds of datasets in the DHS. Among them ‘IndividualWomen’s Records’ was used as this study is based on all ever-married women.ResultsIn the binary logistic and meta-analysis models for Bangladesh, ORs for birth order were 0.57 and 0.51 and for respondents’ age were 1.50 and 1.07, respectively. In all 14 LMICs, the most significant factors for not using institutional facilities during childbirth were respondents’ age (OR 0.903, 95% CI 0.790 to 1.032) and birth order (OR 0.371, 95% CI 0.327 to 0.421).ConclusionBirth order and respondents’ age were the two most significant factors for non-utilisation of healthcare facilities during childbirth in 14 LMICs.

scholarly journals Factors Associated with Migration in Individuals Affected by Leprosy, Maranhão, Brazil: An Exploratory Cross-Sectional Study

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
C. Murto ◽  
C. Kaplan ◽  
L. Ariza ◽  
K. Schwarz ◽  
C. H. Alencar ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Health Sector ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Future Research ◽  
Newly Diagnosed ◽  
Sectional Study ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Factors Associated

In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil’s Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships.

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