scholarly journals Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a retrospective cohort study

2022 ◽  
Author(s):  
Binod Shrestha ◽  
Dan Green ◽  
Manish Baidya ◽  
Tim Chater ◽  
Jiban Karki ◽  
...  
Keyword(s):  
Integrated Management ◽  
Correct Diagnosis ◽  
Health Centre ◽  
Subsequent Treatment ◽  
Health Seeking ◽  
Demographic Differences ◽  
Health Centres ◽  
Child Patient ◽  
To Receive ◽  
Children Under 5

Abstract Background: Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics on under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received.Methods: Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, district, ethnicity, sex, age and temperature of the child were used to predict the number of days taken to seek medical care for Acute Respiratory Infection (ARI), diarrhoea and fever. In addition to this, correct diagnosis and subsequent treatment of pneumonia was assessed against IMNCI guidelines, again using the demographic factors of interest to predict these outcomes.Results: From 116 register books spanning 23 health centres, 33,860 child patient records were considered for analysis. The median age of attendance was 16 months (Inter-Quartile Range= 9, 30), while there were more male children that attended (55.8% vs. 44.2% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p<0.012). Children from underprivileged ethnic groups, Madhesi and Dalit, were less likely to be given a correct diagnosis of pneumonia (p=0.001), while males were more likely to receive a correct diagnosis than females (73% vs. 67%, p=0.001). This sex difference remained in the adjusted regression models for diagnosis of pneumonia (p=0.011) but not for treatment of pneumonia (p=0.202).Conclusions: Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence.

scholarly journals The impact of reimbursed user fee exemption of health centre outpatient consultations for the poor in pluralistic health systems: lessons from a quasi-experiment in two rural health districts in Cambodia

2019 ◽  
Vol 34 (10) ◽  
pp. 740-751 ◽  
Author(s):  
Catherine Korachais ◽  
Por Ir ◽  
Elodie Macouillard ◽  
Bruno Meessen
Keyword(s):  
Public Health ◽  
Rural Health ◽  
Health Centre ◽  
User Fees ◽  
Health Seeking ◽  
The Poor ◽  
Health Centres ◽  
The Impact ◽  
Health Districts

Abstract Fees charged at the point of use are a barrier to the health services’ users, especially for the poorest. Two decades ago, Cambodia introduced the so-called health equity fund (HEF) strategy, a waiver scheme which enhances access to public health services for the poor without undermining the economic situation of facilities. Evidence suggests that hospital-based HEF effectively removed financial barriers and reduced out-of-pocket expenditures. There is less evidence on the effectiveness of the HEF when assistance is extended to the primary level of healthcare. This research explores the impact of a HEF extended to health centres in two rural health districts. Two household surveys and 16-month diary data allowed to assess the impact of the intervention on health-seeking behaviours and expenditure of poor households. Though HEF effectively removed user fees at public health facilities, health centre utilization of sick and poor people did not budge much in the intervention district; self-medication and private provider consultations remained the preferred health-seeking behaviours, by far, even if more expensive. Difference-in-difference estimates confirmed that HEF had a slight impact on health-seeking behaviours, but only for the subgroups of HEF beneficiaries living close to the health centre and ready to test their new entitlement. This research reminds on the importance of the context for the effectiveness of any policy: in a highly pluralistic health sector, waiving already low-user fees in public health centres may be insufficient to increase rapidly the use of those facilities and reduce catastrophic spending. In such context, apart from distance to health centres, perceived quality of services at the health centres, which was relatively low compared with other providers, also matters. Although the HEF scheme plays a role in improving perceived and objective quality of care, complementary means are to be deployed.

scholarly journals Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Marta Blanco ◽  
Pablo Suárez-Sanchez ◽  
Belén García ◽  
Jesús Nzang ◽  
Policarpo Ncogo ◽  
...  
Keyword(s):  
Public Health ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Health Centre ◽  
Regional Hospital ◽  
Malaria Treatment ◽  
Diagnosis And Treatment ◽  
Equatorial Guinea ◽  
Public Health Facilities ◽  
Health Centres

Abstract Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

scholarly journals Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

2021 ◽  
Vol 9 (3) ◽  
pp. e000853
Author(s):  
Michael Topmiller ◽  
Jessica McCann ◽  
Jennifer Rankin ◽  
Hank Hoang ◽  
Joshua Bolton ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Health Centre ◽  
Quality Measures ◽  
Service Area ◽  
Determinants Of Health ◽  
Clinical Quality ◽  
Health Centres

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.SettingsHRSA-funded health centres in the USA.ParticipantsOur analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.ResultsHigher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.ConclusionsThis research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.

scholarly journals Exploring the pregnant women’s perspective of late booking of antenatal care services at Mbekweni Health Centre in Eastern Cape, South Africa

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Ramprakash Kaswa ◽  
George F.D. Rupesinghe ◽  
Benjamin Longo-Mbenza
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Antenatal Care ◽  
Integrated Management ◽  
Health Centre ◽  
Poor Quality ◽  
Eastern Cape ◽  
Structured Interviews ◽  
Care Services ◽  
Late Booking

Background: Antenatal care (ANC) services are the gateway for integrated management of several conditions that adversely affect the mother and foetus. More stillbirths than neonatal deaths in South Africa are a reflection of poor quality ANC services. Aim: The primary aim of this study was to explore the reasons for late booking, and also to determine pregnant women’s knowledge, perceptions and attitude towards antenatal care services they receive in Mthatha area in Eastern Cape, South Africa. Setting: This was a qualitative study, conducted at Mbekweni Health Centre in the King Sabata Dalindyebo (KSD) subdistrict municipality of the Eastern Cape Province. Methods: This qualitative study consisted of selected pregnant women who presented after 19 weeks of gestation at Mbekweni Health Centre. Data were collected through two different methods, namely, semi-structured interviews and focus group discussions were used until saturation of the themes were reached. The interviews were transcribed verbatim and thematic analyses were undertaken. Results: Twenty women participated in the study. They were diverse in terms of age 18–41 years, gravidity 1–6 and time of ANC booking 20–28 weeks. The interviews identified a variety of personal, service and organisational reasons for late ANC booking. The themes identified for late ANC bookings were: health care system related issues, socio-economic factors, women’s perceptions and knowledge, and failure of family planning services. Conclusions: Women’s beliefs, knowledge and perceptions regarding antenatal services outweigh the perceived benefit of early ANC visit. The majority of women had lack of knowledge of contraception, early signs of pregnancy, purpose, timing and benefits of ANC visit.

scholarly journals Second Year Nursing Students’ Experiences of Clinical Placement in a Rural Health Centre

2018 ◽  
Vol 3 (2) ◽  
pp. 107
Author(s):  
Vistolina Nuuyoma ◽  
Daniel Opotamutale Ashipala
Keyword(s):  
Nursing Education ◽  
Nursing Students ◽  
Rural Health ◽  
Positive Impact ◽  
Health Centre ◽  
Learning Context ◽  
Rural Health Centre ◽  
Satellite Campus ◽  
Health Centres ◽  
Second Year

Introduction: In nursing education, it is expected that students take theoretical and practical courses. Practical components are an integral part of learning in nurses’ training, which is effected through placement of students in different clinical settings. In Namibia, hospitals, clinics and health centres are popularly utilized as a clinical environment for placing nursing students at all levels of studies. However, little is known on how students experience the placement at the health centres. In 2016 Nursing students from a satellite campus were placed at a health centre.Methods: The study followed qualitative research principles, and it was explorative, descriptive and contextual in nature. Data were collected from reflections submitted by second year nursing students from a UNAM satellite campus upon completion of their two weeks placement at a health centre in 2016. Data were analyzed using content analysis as a data analysis strategy. Trustworthiness of this study was ensured by applying the criteria of Lincoln and Guba, namely: credibility, transferability, dependability, and confirmability of the study.Results: The five themes that emerged from the study are: ‘interpersonal factors’, ‘students’ reactions to the learning context’, ‘enablers of students’ learning at a rural health centre’, ‘challenges experienced by students’, and ‘recommendations made by students on learning in a rural health centre’.Conclusion: It is evident that good interpersonal interaction between nursing staff, students and patients appear to have a positive impact on learning. Students reflected on limited supply of equipment, and limited cases available as challenges experienced during their placement. Furthermore, students made suggestions to improve placements in a rural health centre.

scholarly journals Biological Control Associated With Plant Nutrition for Meloidogyne javanica and Pratylenchus brachyurus Management in Soybean

2019 ◽  
Vol 12 (1) ◽  
pp. 149
Author(s):  
Ana Paula Mendes Lopes ◽  
Bruna Orlandini Toninato ◽  
Mayra Renata Cruz Soares ◽  
Cláudia Regina Dias-Arieira
Keyword(s):  
Biological Control ◽  
Plant Nutrition ◽  
Aerial Part ◽  
Integrated Management ◽  
Meloidogyne Javanica ◽  
Control Methods ◽  
Pratylenchus Brachyurus ◽  
Low Efficiency ◽  
To Receive ◽  
Nematode Mortality

Meloidogyne javanica and Pratylenchus brachyurus stand out among the main nematodes in soybean crops. Research on integrated management are often conducted, due to the low efficiency of the main control methods when they are applied alone. Thus, the aim of the present study was to assess the potential of biological control and plant nutrition products to control these nematodes in soybean. The effect of each product alone on nematode hatching and mortality was also assessed. A greenhouse experiment was also carried out, evaluating five doses of the product for biological control based on Bacillus and Trichoderma, with and without the presence of the product for nutrition, inoculated with 2000 eggs and juveniles for the gall nematode or 1000 specimens for the nematode lesions. After 30 days of multiplication, the aerial part was removed and the soil was revolved to receive the new sowing of the soybean with the respective treatments mentioned above. After 60 days, the experiments were evaluated for nematological parameters. Both products reduced hatching and increased nematode mortality. Treatments with biological control were efficient in reducing M. javanica and P. brachyurus, mainly when applied at doses close to 5 and 8 kg ha-1, respectively. The nutrition product negatively influences the biological control.

scholarly journals Factors Influencing Utilization of Ultrasound Scan Services among Pregnant Mothers at Ndejje Health Center IV, Wakiso District

2020 ◽  
Author(s):  
◽  
Angella Nakimera
Keyword(s):  
Health Facility ◽  
Waiting Time ◽  
Health Centre ◽  
Ultrasound Scan ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Study Results ◽  
To Receive ◽  
Pregnant Mothers

Abstract Background: A study was carried out to identify the factors influencing the utilization of ultrasound scan services among pregnant mothers at Ndejje Health Centre IV, Wakiso District. Methodology: The study design was descriptive and cross-sectional and it employed both quantitative and qualitative data collection methods. A sample size of 30 respondents was selected using a simple random sampling procedure. An interview guide was used to collect data. Results: The study revealed various factors influencing the utilization of ultrasound scan services among pregnant mothers. For example, although all 30 (100%) had ever heard about ultrasound scan services, most 20 (66.7%) had ever used ultrasound scan services once 10 (50%) and 12 (60%) used the services in the 3rd trimester due to factors including 20 (66.7%) of ultrasound scan services, 21 (70%) having fears about using ultrasound scan services including 14 (66.7%) fear that the scan would identify bad conditions on the baby, 18 (60%) lacked partner support. The study results also revealed that respondents faced various health facility factors which influenced the utilization of ultrasound scan services. For example, most 20 (66.7%) respondents reported that Ndejje Health Centre IV was not equipped to provide ultrasound scan services due to 12 (60%) frequent breakdown and poor maintenance of equipment which led to 18 (60%) ultrasound scan services not being readily available, 12 (60%) long waiting time to receive services as most waited more than 2 hours to receive services. Conclusion and recommendations: Respondents faced various and health facility-related factors which influenced their utilization of ultrasound scan services. The key recommendations included ready availability of services through regular and timely maintenance of equipment, improving efficiency, and reducing waiting time as well as improved health education of mothers about the importance of using the services.

scholarly journals Does Motivation Contribute on Health Care Provision?

2018 ◽  
Vol 8 (2) ◽  
pp. 315
Author(s):  
Elizabeth Landa
Keyword(s):  
Public Health ◽  
Social Security ◽  
Working Condition ◽  
Health Centre ◽  
Team Work ◽  
Social Security Fund ◽  
Customer Care ◽  
Significant Difference ◽  
Health Centres ◽  
Security Fund

This study aimed to examine the contribution of employee motivation on provision of customer care in public health centres, in Morogoro Municipality. Data were collected from four selected public health institutions namely Morogoro General Hospital, Nunge Health Centre, Mafiga Health Centre and Kingolwila Health Centre respectively. The sample of 124 respondents were used, that is; employees and heads of the health centres. Collected data were coded using SPSS, where frequencies, percentages and chi-square were employed. The study identified that career development, training, appreciation, recognition, membership to the Social Security Fund, team work, working condition, paid leave, housing allowances and acting allowance were, the motivation schemes provided to public health employees. However public health workers are motivated by being a member on social security fund, medical cover, supervision, and job security. The result shows that there is significant difference between the employee who are motivated and those who are not motivated with regard to their provision of customer care to patients. The study concludes that most of the employees are not motivated by the existing motivation schemes which consequences lower their ability to provide the appropriate health services. The study recommends that strategies for improving motivation of employee to improve customer care include increase salary, improve working condition, pay housing allowance to all employees, allowance such as leave, overtime should be paid on time, promotion should be made in appropriate time and fair.

FC24-02 - Psychiatric literacy and the personality disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 1947-1947
Author(s):  
J. Winceslaus ◽  
A. Furnham
Keyword(s):  
Personality Disorders ◽  
Correct Diagnosis ◽  
Psychological Problem ◽  
List Type ◽  
Health Seeking ◽  
The Public ◽  
Lay People ◽  
History Of ◽  
The Media ◽  
Psychological Education

IntroductionThis study explored the unknown psychiatric literacy of the public with regard to the Personality Disorders (PDs).ObjectivesTo find out -i)Whether a lay person recognises the presence of a psychological problem in a person with a PD.ii)What labels lay people give to people living with PDs.iii)How lay people rate the quality of life of people living with PDs.iv)Whether a history of psychological education or illness improves a lay person's ability to identify a PD.AimsTo assess how much work is needed to be done in order to increase public psychiatric literacy to a satisfactory level with regard to the PDs.MethodsA vignette identification methodology was employed. 223 participants responded to the questionnaire Eccentric people’. Results: Lay people recognise people with PDs as being unhappy, unsuccessful at work and as having poor personal relationships, but do not associate these problems with psychological causes. Rates of correct labelling were low; under 7% for 7/10 PDs. History of psychological education and illness were positively correlated with the correct recognition of 70% and 60% of the personality disorders respectively.ConclusionsThe psychiatric literacy of the public with regard to the PDs is low. This raises concerns about the health seeking behaviour and correct diagnosis of sufferers, as well as the stigma attached to them and their social neglect by others. Psychiatric literacy needs to be increased, psychological education achieves this. The media could be an effective tool to increase psychiatric literacy.

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