Applied Medical Anthropology and Structurally Informed Emergency Care in the Evolving Context of COVID-19

This article describes the integration of medical anthropologists as direct members of health care teams within a large, urban teaching hospital as a means to address the role of structural inequality in unequal health care delivery within the context of COVID-19. The pandemic starkly underlined the role structural forces such as food insecurity, housing instability, and unequal access to health insurance play among vulnerable populations that seek health care, particularly within the emergency department (ED). There is a critical need to recognize the reality that disease acquisition is a cultural process. This is a significant limitation of the biomedical model, which often considers disease as a separate entity from the social contexts in which disease is found. Further, a focus on patient-centered care can open the door for critical, clinically applied, medical anthropologists to team with physicians, merging ethnographic methods with health data and the socially constructed realities of patients’ lived experience to build new pathways of care. These pathways may better prepare physicians and health care systems to respond to novel threats like COVID-19, which are rooted in pathophysiological origins but have outcome distributions driven by cultural and structural determinants. To this end, we propose a reconfiguration of dominant biomedical ideologies around disease acquisition and spread by examining our work since 2018, which sees anthropologists embedded both locally and systematically in the creation of anthropologically informed treatment pathways for socially complex disease states like HIV, Hepatitis C, and Opioid Use Disorder (Henderson 2018). Understanding how these socially complex diseases concentrate and interact in populations is a potential opportunity to model solutions for other widespread and complex health care crises, including COVID-19.

Evaluation of Tele-rheumatology during the COVID-19 Pandemic in Asian Population: A Pilot Study

Objective. Rheumatoid arthritis (RA) is a chronic autoimmune condition associated with a potential for deformities. It is one of the common conditions to seek health care. Hence, the present study was conducted to assess the telemedicine services for patients suffering from rheumatoid arthritis during the COVID-19 pandemic in an Asian Indian population. Methods. A prospective study was conducted (March 2020–June 2020) in the telemedicine department of a premier northern Indian tertiary care institution. Out of the total patients enrolled ( N = 7577 ) in telemedicine services, 122 rheumatoid arthritis patients (1.6%) were followed for 1 month to assess change in functional status by modified Health Assessment Questionnaire (mHAQ). Telephonic interviews of the enrolled patients were conducted to determine the level of understanding of advice given by consultants, barriers during the consultation, and satisfaction with teleconsultations for rheumatology clinics. Results. For the native people, language of the clinicians was the main barrier (20%) in telerheumatology. Saving of time and money was observed as beneficial factors for patients. More than three-quarters of all rheumatoid arthritis patients were ready to use teleconsultation in the near future. A similar proportion of patients were in support for the recommendation of these services to other persons. Conclusion. We report the successful use of telemedicine services in the evaluation and management of rheumatic diseases in the current COVID-19 pandemic situation.

Physical Injuries and Burns among Refugees in Lebanon: Implications for Programs and Policies

Background: Refugees are prone to injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study systematically quantified the prevalence of physical injuries and burns among the refugee community in Western Lebanon and examined injury characteristics, risk factors and outcomes. Method: We conducted a cluster-based population survey across 21 camps in the Bekaa region of Lebanon from February to April 2019. A modified version of the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool v 3.0 was administered to the head of the refugee household and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables. Results: 750 heads of household were surveyed. 112 (14.9%) household sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Most injuries occurred inside the tent (29.9%). A burn was sustained by at least one household member in 136 (18.1%) households. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers have the inability to lockout children while cooking (25.6% vs 14.9%, p-value=0.001). Similarly, households with unemployed head significantly had more reported burns (19.7% vs 13.3%, p-value=0.05). Nearly 16.1% of injured refugees were unable to seek health care due to lack of health insurance coverage and financial liability. Conclusion: Refugees suffer injuries and burns with substantial human and economic repercussions on individuals, their families and the host healthcare system. Resources should be allocated to designing safe camps and implementing educational and awareness programs with special focus on heating and cooking methods.

Tuberculosis amongst foreign-born and nationals: different delays, different risk factors

Background Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. Methods We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. Results Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). Conclusions Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.

Quality of provider-client interaction in a reproductive health clinic in Isabela, Philippines

The quality of provider-interaction determines client satisfaction and decision to seek health care. This research aimed to determine the women clients’ perception of their quality of interaction with the health care providers in a government reproductive health clinic in one of the municipalities in northern Philippines. Respondents consisted of 30 pregnant women who had visited the clinic for prenatal health care check-up were interviewed. A structured questionnaire and a semi-structured guided for probing served as the study’s research instruments. Women perceived the health care providers to possess good communication skills, and had displayed behavior that showed a regard for them. However, the providerinteraction was considered to be unilinear, with the provider perceived to have dominated the interface, The women also perceived only a somewhat evident show of sympathy/empathy. Hostile words were heard frequently. Creation of a two-way interaction with respect for their clients must be considered by the health care providers. Policies must also be formulated to improve the quality of provider-client interaction inside reproductive health clinics.

An Analysis of Causes and Avoidable Factors of Perinatal Deaths at Tertiary Care Hospital

Introduction: Perinatal deaths are potentially preventable and reflect the quality of care provided in the prenatal period, during labor, and to a newborn. The purpose of this study was to assess the causes and avoidable factors contributing to perinatal deaths in the year 2018-19 and compare these with the previous two years at Tertiary Care Hospital.Materials and Methods: This study was conducted from a retrospective analysis of all stillbirths and early neonatal deaths in the year July 2018 to July 2019. The Perinatal Mortality Rate, causes, and avoidable factors leading to perinatal deaths were analysed during this year and were compared with that of the previous two years at KIST Medical College and Teaching hospital.Results: PMR was 16.09 per 1000 births in the year 2018-19. Previous two studies at this hospital in the year 2017-18 and 2016-17 showed a Perinatal Mortality Rate of 14.61 and 16.27/1000 births respectively. The commonest primary cause of perinatal deaths was intrapartum hypoxia 6 (30%), preterm delivery 5 (31.25%), and congenital anomalies4 (19%) during the year 2018-19, 2017-18, and 2016-17 respectively. The most common avoidable factors identified were a maternal delay to seek health care, inadequate antenatal checkups, and inadequate antenatal counseling of danger signs by a service provider over the last three years.Conclusions: Maternal delay to seek health care and lack of maternal knowledge of danger signs during pregnancy were the common avoidable factors identified. More efforts should be made to raise awareness of pregnant women during antenatal care visits regarding early healthcare-seeking behavior when needed.

Prevalence of self-medication with antibiotics and its related factors among Chinese residents: a cross-sectional study

Background Self-medication is one of the most common forms of inappropriate use of antibiotics. This study aimed to assess the prevalence of self-medication with antibiotics (SMA) in China and evaluate the related factors. Methods A cross-sectional survey was conducted in Wuhan, Hubei, China from July 1, 2019 to July 31, 2019. Participants were recruited in public places to answer a structured questionnaire. The information of participants’ social demographic characteristics, antibiotic knowledge and health beliefs were collected. Binary Logistics regression analysis was used to examine the associated factors of SMA. Results Of the 3206 participants, 10.32% reported SMA in the past 6 months. Participants who with middle or high perceived barriers to seek health care services showed a higher likelihood of SMA (P < 0.05). Participants who with middle or high perceived threats of self-medication, and who with middle or high self-efficacy to overcome obstacles showed a lower likelihood of SMA (P < 0.05). Conclusions Compared with developed countries, the prevalence of SMA in China is still higher. Measures to conduct public health education and improve the accessibility of health services are crucial to decrease the overall self-medication rate in China.

Immigrant Sanctuary or Danger

Hospitals have for centuries been considered safe havens for immigrants and people on the move. However, immigrants and migrants who seek health care have also been targeted for exclusion and deportation. This article discusses the history of how hospitals and health care facilities in the United States have acted both as sanctuaries and as sites of immigration enforcement. This debate came to a head in California in the 1970s, when conservatives began attacking local public health facilities’ informal sanctuary practices. Following the California battles, which culminated in Proposition 187 in 1994, immigrant rights movements have increasingly connected calls for sanctuary with demands for a right to health care.

Irritable bowel syndrome in midlife women: a narrative review

Midlife women between the ages of 40 and 65 years have reported multiple challenges due to menopausal, developmental, and situational transitions from younger to older adulthood. During the midlife period, many women seek health care for gastrointestinal symptoms and irritable bowel syndrome (IBS). Multiple factors including stress, poor sleep, diet, and physical inactivity may contribute to IBS or gastrointestinal symptoms in midlife women. As such, a comprehensive assessment and treatment approach is needed for midlife women suffering gastrointestinal symptoms. This article reviews the main aspects of the menopausal transition, sex hormonal changes, abdominal and pelvic surgery, psychosocial distress, behavioral factors, and gut microbiome, as well as their relevance on IBS and gastrointestinal symptoms in midlife women. Also, management strategies for IBS in midlife women are discussed. To date, gastrointestinal symptoms during midlife years remain a critical area of women’s health. Additional research is needed to better understand the contributors to gastrointestinal symptoms in this group. Such efforts may provide a new window to refine or develop treatments of gastrointestinal symptoms for midlife women.

Predictors of Health Seeking Behaviours for Common Childhood Illnesses in Poor Resource Settings in Zambia, A Community Cross Sectional Study

Background: Developing countries, including Zambia, account for larger share of child morbidities and mortalities due to common childhood illnesses. Studies on wider determinants of behaviour pertaining to treatment seeking for childhood febrile illnesses in poor resource settings are limited. This study investigated health seeking behaviours of mothers in poor resource settings of Zambia and identified associated factors.Methods: Secondary data from a community cross sectional study design from the Health for the Poorest Population (HPP) Project was analysed between March and May 2019. Data was collected between May and August, 2013. It was collected by means of administering a structured questionnaire from the mothers of under-five children. The survey took place in Samfya and Chiengi of Luapula province while in Northern Province, Luwingu and Mungwi were settled for. A total of 1 653 mothers of under 5 years who had an episode of diarrhoea, malaria, pneumonia or a combination of any of them not more than 14 days before the interview were included in the study. A sample size was arrived at using A Lot Quality Assurance Sampling (LQAS) method. In order to determine the associations between respondent's demographic characteristics and health seeking behaviour, chi square test of independence was carried out. Multivariable logistic regression was also done to identify predictors of health seeking behaviours for common childhood illnesses in children aged &lt;5 years old in poor resource settings.Results: Among the mothers interviewed, 64.6% were married while 35.4% were unmarried. Their mean age was 32 years. Mothers who took their sick children to the health facilities for the purpose of seeking health care for their child for either of the illnesses accounted for 75.2%, [95% CI: 0.62–0.96], while 24.8% did not seek health care for their sick child. Factors typically associated with health seeking behaviours were mothers' marital status [aOR = 0.74; 95% CI: 0.58–0.94], and mothers ‘education level [aOR = 1.47; 95% CI: 1.13–1.92].Conclusion: It was established in this study that health care seeking behaviours for these common childhood illnesses in poor resource settings was relatively high and could be predicted by mother's education level and mothers' marital status. Integrating interventions targeted at increasing utilisation of maternal and child health services with basic education to women and moral support counselling to families may potentially maximise health seeking behaviours in marginalised communities.