scholarly journals Parental Outlook and Problems Faced during Lockdown in COVID-19 Pandemic: Experience from a Paediatric Haematology-Oncology Unit in a Developing Country-A Questionnaire-Based Survey

2021 ◽  
Author(s):  
Supriya Maheshwari ◽  
Sumit Mehndiratta ◽  
. Amitabh
Keyword(s):  
Low Income ◽  
Virus Disease ◽  
Financial Burden ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Healthcare Services ◽  
Tertiary Care Centre ◽  
Middle Income ◽  
Paediatric Haematology ◽  
Oncology Unit

Introduction: Corona Virus Disease 2019 (COVID-19) pandemic has resulted in disruption of essential healthcare services. Children with cancer are very vulnerable group and delay in seeking treatment or defaulting scheduled medications adversely affects the outcome. Aim: To obtain insight into barriers and to evaluate concerns, outlook and challenges faced by parents of children suffering with malignancy in accessing the healthcare services during lockdown imposed due to COVID-19 pandemic. Materials and Methods: A questionnaire-based survey was conducted from parents of children newly diagnosed (during lockdown restrictions) with malignancy and previously diagnosed and under treatment at Paediatric Haematology Oncology unit in a Tertiary care centre. The responses were recorded in predesigned proforma during 15 days period after restrictions were relaxed. Results: Fifty-five responses were recorded and analysed. Father was the respondent in most cases. Acute Leukaemia (n=37) and Lymphoma (n=14) patients comprised majority of the patients. Major challenges faced were transportation (98.2%), financial burden (96.4%) and loss of job (65.4%). Fear of contracting COVID-19 infection was a primary barrier in seeking treatment for most respondents. Conclusion: The success and outcome of children with malignancy has been suboptimal in low-income and middle-income countries due to effect of lack of timely access of healthcare services, delayed diagnosis, treatment abandonment, poor compliance and financial constraints. The COVID-19 pandemic and associated setbacks have accentuated these factors and may have long term impact in final outcome for such patients.

scholarly journals Impact of Medical Debt on the Financial Welfare of Middle- and Low-Income Families across China

2020 ◽  
Vol 17 (12) ◽  
pp. 4597 ◽  
Author(s):  
Jiajing Li ◽  
Chen Jiao ◽  
Stephen Nicholas ◽  
Jian Wang ◽  
Gong Chen ◽  
...  
Keyword(s):  
Low Income ◽  
Concentration Index ◽  
Financial Burden ◽  
Medical Insurance ◽  
Tobit Regression ◽  
Middle Income ◽  
Medical Debt ◽  
Low Income Families ◽  
Low And Middle Income

Background: Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. Method: Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. Results: We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. Conclusions: Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China’s basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.

scholarly journals The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

2020 ◽  
Vol 105 (10) ◽  
pp. 927-931 ◽  
Author(s):  
Mike English ◽  
Brigid Strachan ◽  
Fabian Esamai ◽  
Thomas Ngwiri ◽  
Osman Warfa ◽  
...  
Keyword(s):  
Public Sector ◽  
Low Income ◽  
Tertiary Care ◽  
Leadership Role ◽  
Multiple Sources ◽  
Middle Income ◽  
The Public ◽  
Local Expert

ObjectiveTo examine the availability of paediatricians in Kenya and plans for their development.DesignReview of policies and data from multiple sources combined with local expert insight.SettingKenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents.ResultsThere are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers.DiscussionThe scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.

scholarly journals Unravelling the magic of latent safety threats

2020 ◽  
Vol 3 (2) ◽  
pp. 15-18
Author(s):  
David Yadin
Keyword(s):  
Low Income ◽  
Medical Equipment ◽  
Health Technology ◽  
Healthcare Services ◽  
Clinical Engineering ◽  
Biological Engineering ◽  
Time Data ◽  
Middle Income ◽  
Sociotechnical System ◽  
Dental Offices

Sterile processing errors in medical and dental offices are ranked the third highest hazard according to the annual ECRI ‘Top 10 Health Technology Hazards’ 2020 report. Other experts have raised similar concerns with sterilisation processes. For example, the WHO and the Clinical Engineering Division of International Federation of Medical and Biological Engineering (IFMBE) have partnered to provide a series of webinars with international experts exchanging knowledge on COVID-19 related critical topics. A recent webinar addressed the critical challenge of decontamination and disinfection of COVID-19 medical equipment in low-income and middle-income countries. During the webinar, participants asked about methodologies to assess whether the transmission of infection is borne by technological tools used to fight the disease. How can critical lifesaving breathing equipment be safely and quickly sterilised and moved from one patient to the next? The WHO/IFMBE webinar2 stated that ‘engineers and infection control professionals seem to be working in different silos’. Such silos must be dismantled because medical technology is indispensable in the provisioning of healthcare services. Disinfection and sterilisation of medical equipment are key concerns for healthcare organisations, and they require serious consideration of sociotechnical system interactions. The annual ‘top 10 Health Technology Hazards report’ is based on retrospective studies, yet management of COVID-19 safety requires capacity to process real- time data and the input of experts to predict where risks may occur and how to deploy plans to maintain a safe healthcare environment.

scholarly journals Recommending form of anticancer drugs in oncology unit of a tertiary care teaching hospital

2021 ◽  
Vol 12 (2) ◽  
pp. 1201-1207
Author(s):  
Pandiamunian Jayabal ◽  
Nithiya Dhanasekaran ◽  
Shanmugasundaram S
Keyword(s):  
Anticancer Drugs ◽  
Care Delivery ◽  
Demographic Data ◽  
Tertiary Care ◽  
Dose Intensity ◽  
World Health ◽  
Tertiary Care Centre ◽  
Cost Effective Treatment ◽  
The World ◽  
Oncology Unit

Cancer has become a chief ailment and danger to the global society. It is one of the foremost reasons for demise in the world. A survey by the World Health Organization (WHO) indicates that 8.2 million people died from cancer in 2012 and it may rise to 19 million by 2025. Drug interactions connected through anticancer drugs are a global concern and should not be ignored. Nausea, vomiting or some other mild response to extreme myelosuppression may vary from adverse drug reactions. Analysis of prescription trend is a possible method in ascertaining the position of drugs in culture and it has to be taken out at every hospital regularly. The research is developed to examine the prescription pattern of anticancer drugs in the clinical oncology unit of a tertiary care centre in India. The patient's demographic data, medication name, type, dose, intensity and duration etc., have been analyzed in each prescription  Commonly utilized anticancer narcotics and different forms of cancer were identified and the national essential drug list percentage of the medicines used was analysed. The current study intended to assess the tendencies and pattern of prescribing anticancer drugs. The prescribing practises were apposite and were in agreement with WHO strategies. The present study seemed to sustenance best proposing performs in order to endorse cost effective treatment and improved health care delivery.

scholarly journals A STUDY TO DOCUMENT LIFESTYLE ASSOCIATED RISK FACTORS FOR NON COMMUNICABLE DISEASES AMONG ADOLESCENTS

2020 ◽  
pp. 14-15
Author(s):  
Gunjan Jain ◽  
Jigisha Patadia ◽  
Praful Bambhroliya
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Low Income ◽  
Communicable Disease ◽  
Tertiary Care ◽  
Age Groups ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Primordial Prevention ◽  
Associated Risk Factors

The burden of morbidity and mortality from Non-Communicable disease has risen worldwide and is accelerating in low-income and middle-income countries. Lifestyle-associated risk factors among adolescent are rampantly increasing throughout the world. They place a tremendous demand on health care systems and social welfare, cause decreased productivity in the workplace, prolong disability and diminish resources within families. A life course approach to preventive efforts addressing NCDs and their risk factors and behaviors will improve child and adolescent health but also decrease lifetime health care costs. Nevertheless, those risk behaviors are initiated usually in the adolescent’s age groups which are continued to adult. Therefore, this group is important target for primordial prevention. This study is a cross-sectional study which aims to determine the prevalence of risk factors among adolescents attending the tertiary care centre in Surat, district of Gujarat, conducted in March 2019 to June 2019. A total of 498 adolescents were screened using a structured questionnaire. The study documented that improper diet is the major risk factor while habits like smoking and alcohol consumption is fairly uncommon. Study recommends creating awareness among adolescents and promoting healthier lifestyle habits.

scholarly journals The pattern of suicide poisoning cases in the Tertiary care Centre in Chengalpet district, Tamil Nadu, India

2021 ◽  
Vol 8 (7) ◽  
pp. 3512
Author(s):  
R. Swaminathan Veerasamy ◽  
V. Pragadeesh Raja ◽  
T. Muthukumar ◽  
A. Kalaivani
Keyword(s):  
Tamil Nadu ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Tertiary Care Centre ◽  
Important Public Health Problem ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Socioeconomic Status ◽  
Socio Demographic Factors

Background: Suicide is an important public health problem, every year 800000 people due to suicide, Suicide is the third leading cause of death in 15-19-year-old only. Most (79%) of the suicide happened in low and middle-income countries. Among them consuming poisoning is 25.8%. In India 2019 incidence of suicides 10.4 per one lakh (1,00,000) of population. Tamil Nadu is the state of India sharing most of the suicide deaths, second position (9.7%) in 2019 next to Maharashtra (13.6%).Methods: This is a Hospital-based cross-sectional study, this study was conducted among suicide patients who consumed poison by using nonprobability, consecutive sampling. A pretested questionnaire was administered, and information regarding socio-demographic factors, type of poisoning, and outcome of poisoning was obtained. Statistical analysis was done through Statistical package for social sciences (SPSS) version 21.Results: Of 111 suicide poisoning patients admitted, were female (50.5%) and the majority were from a rural area (70.3%). Among suicidal, tablet poisoning was predominant (27.7%), followed by Organophosphorus poisoning (26.8%) and rat killer poisoning (17.1%). The major reason for suicidal poisoning was family problems (58.6%), and the majority of Suicidal poisoning was more among the age group of 11–30 years (67.6%) and middle socioeconomic status (50.5%). The majority of patients were admitted to the hospital with median days of 2 days (range 1-12). Among 111 patients 109 are cured and discharged and death of 2 cases.Conclusions: Suicides are avoidable and preventable deaths, there are so many measures are there in individuals levels particularly high-risk persons and community level also. So many poisoning cases are tablets and organophosphorus so to take steps for reducing access for that like legislative measures and regulations. Early identification of the mentally disturbed persons and to give counselling.  

Dihydro pyrimidine dehydrogenase deficiency in patients treated with capecitabine-based regimens: A retrospective tertiary care centre experience.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 712-712
Author(s):  
Arvind Sahu ◽  
Vikas S. Ostwal ◽  
Anant Ramaswamy
Keyword(s):  
Dose Reduction ◽  
Dose Range ◽  
Dihydropyrimidine Dehydrogenase ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Exon 2 ◽  
Hand Foot Syndrome ◽  
Life Threatening ◽  
Grade 3 ◽  
Oncology Unit

712 Background: Capecitabine is an integral part of treatment of gastrointestinal cancers. Dihydropyrimidine dehydrogenase (DPD) enzyme is rate limiting in the metabolism of capecitabine, deficiency of which leads to myelsuppression, mucositis, diarrhea, hand foot syndrome (HFS) and rarely, death. Data regarding the toxicity of capecitabine in patients with DPD deficiency in the Indian context is scarce. Methods: 506 patients were treated with capecitabine containing regimens with a dose range of 1250 mg/m2/day to 2000 mg/m2/day during the period from June 2013 to May 2015 in the Gastrointestinal Medical Oncology Unit of our institution. Patients with Grade 3/4 toxicities requiring in-patient care (life threatening complications) were planned for DPD activity testing by Peripheral Blood PCR sequencing. Results: 27 patients developed Gr 3/4 toxicities during cycle 1 of capecitabine. It included mucositis in 22 (81.5 %), diarrhea in 25 (92.6%), HFS in 10 (37%) and myelosuppression in 4 (14.8%). 19 were found to be DPD deficient with 5 patients negative for DPD mutation. 3 patients did not do the DPD analysis as advised. Homozygous mutations were seen in 9 (33.3%) and heterozygous mutations in 10 (27%) of patients. More than one mutation was seen in 10 patients (37%). The relative frequencies of mutation were Exon 14 (44.4%), Exon 2 (25.9%), Exon 13 (25.9%), Exon 6 (11.1%) and Exon 18 (7.4 %). Post Cycle 1 of capecitabine, the drug was stopped in 5 patients (18.5%), regimen changed in 2 (7.4%) and dose reduction by 50% of the drug was done in the remaining patients. Despite dose reduction and change in therapy during Cycle 2, patients still had Grade 3/4 toxicities including mucositis in 7(25.9%), diarrhoea in 10 (37%), HFS in 7 (25.9 %) and myelosuppression in 6 (22%) of patients. Conclusions: Capecitabine can also lead to severe toxicities in DPD-deficient patients. Dose reduction of capecitabine in DPD deficient patients may not completely ameliorate the future risk of life – threatening complications. Screening for DPD deficiency prior to administration of capecitabine in toxicity prone nutritionally deficient Indian patients should be further evaluated based on this data.

AN OBSERVATIONAL RETROSPECTIVE STUDY TO EVALUATE THE NON-RESPIRATORY PROTEAN MANIFESTATIONS OF COVID-19 PATIENTS -EXPERIENCE OF A DEDICATED CORONA TERTIARY CARE CENTRE IN NORTHWESTERN INDIA

2021 ◽  
pp. 11-13
Author(s):  
Aradhana singh ◽  
H.L. Saini ◽  
Khushboo Khushboo ◽  
Abishek Yadav ◽  
C.L. Nawal
Keyword(s):  
Respiratory System ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Short History ◽  
Gastrointestinal Involvement ◽  
Tertiary Care Centre ◽  
Exclusion Criteria ◽  
Northwestern India ◽  
Pulmonary Manifestations ◽  
Patients Experience

INTRODUCTION - COVID-19 was primarily considered as a respiratory disease and pulmonary manifestations were the most common presentation. However, as the months passed after the declaration of covid -19 as pandemic, our knowledge regarding the symptomatology become wiser and it was found that SARS-CoV-2 infection is not limited to the respiratory system alone and other organs are also being affected. This study is aimed to characterize the non-respiratory symptomatology and the unusual manifestations of covid-19 in patients with laboratory conrmed SARS-CoV-2 infection admitted to SMS hospital Jaipur, so that Covid-19 can be diagnosed early to prevent complications arising out of misdiagnosis or delayed diagnosis. METHODOLOGY- The presented study was designed at a single center as an observational study done retrospectively in around 200 patients chosen randomly, being admitted during lockdown period from March 2020 to May 2020 in our dedicated covid hospital, Jaipur, Rajasthan after applying inclusion and exclusion criteria. Their clinical prole and symptomatology were noted and analyzed. RESULTS- In our study out of 200 patients recruited, obesity was the most common comorbidity (14.5%) and the most common protean manifestations were due to gastrointestinal involvement (17%). CONCLUSION- SARS-CoV-2 not only affect the respiratory tract, but can affect any system without involving respiratory system at all and it should always be kept as differential diagnosis while evaluating a patient with a short history in this covid era.

scholarly journals Ten-year impacts of China’s rural health scheme: lessons for universal health coverage

2021 ◽  
Vol 6 (4) ◽  
pp. e003714
Author(s):  
Yaoguang Zhang ◽  
Di Dong ◽  
Ling Xu ◽  
Zhiwen Miao ◽  
Wenhui Mao ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Low Income ◽  
Rural Population ◽  
Financial Risk ◽  
Financial Burden ◽  
Medical Expenditure ◽  
Service Utilisation ◽  
Health Coverage ◽  
Middle Income ◽  
Universal Health

China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees’ service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China’s two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC.

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