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PubMed1989

Access to health care in urban areas of developing societies.

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.

Community Health Services↗
PubMedDate not supplied

The accessibility of abortion services in the United States.

Abortion services are provided in hospitals, doctors' offices and various types of clinics, but about two-thirds of procedures are performed in specialized abortion clinics. While this system appears to work well for most women, some women seeking abortion face obstacles related to distance, cost, harassment and special medical conditions. Nine percent of nonhospital abortion patients must travel more than 100 miles and 18 percent travel 50 to 100 miles for services. The average woman having a first-trimester nonhospital abortion paid $251 in 1989. Fees were higher in facilities with small abortion caseloads. An abortion at 10 weeks' gestation in a hospital cost an average of $1,757. Charges for abortions at 16 weeks averaged $509 in abortion clinics, compared with $1,539 in hospitals for curettage and $2,246 for instillation procedures. Some women face other barriers: Only 43 percent of all abortion facilities offer services past 12 weeks, and 27-37 percent of nonhospital facilities say they do not treat patients who test positive for the human immunodeficiency virus (HIV), the virus that causes AIDS. Women who need special services such as an administration of Rh immunoglobulin, general anesthesia or HIV testing usually pay extra for these services. In addition, 85 percent of nonhospital facilities that serve 400 or more abortion patients a year reported some form of antiabortion harassment in 1988, most commonly picketing; there was virtually no change in this proportion between 1985 and 1988.

Abortion, Legal↗
PubMed1997

Observed versus expected obstetric complications: an assessment of coverage of obstetric care in developing countries.

The objective of this study was to evaluate access to obstetric care in a rural district in East Africa using easily collected and evaluated data and avoiding expensive field surveys, complicated study design or statistical methods. The number of observed obstetric complications occurring during 12 months in a rural East African district hospital (the only institution with surgical facilities and access to blood transfusion in the district) were compared to the number of expected complications the district should 'generate'. Of the expected > 10000 deliveries < 25% took place in the district hospital. The place of confinement for the other deliveries was not determined. As compared to the total number of expected conditions within the study district < 25% of the breech and < 45% twin deliveries took part in the district hospital and < 10% of pregnancies complicated by placental abruptions and < 5% of the pregnancies complicated by placenta praevia were managed in the district hospital. Comparing the number of serious pregnancy complications which were managed in the hospital to the total expected number for a particular region allows a simple assessment of the accessibility of obstetric care. This ratio might be more useful when evaluating obstetric care than traditional parameters as it stresses the importance of accessibility of care for the whole community.

Africa↗
PubMed1991

Indicators of accessibility to primary health care coverage in rural Odukpani, Nigeria.

Indicators of accessibility were investigated in Odukpani Local Government Area using a structured questionnaire administered to mothers or heads of households in the study area. The indicators considered included proportion of births attended by trained health personnel, proportion of children with diarrhea treated with oral rehydration therapy (ORT), distance from home to regular immunization site, and acceptability of primary health care services to the target population. Sociodemographic data revealed a typical developing country population profile and surprisingly high literacy rate (57.8%) relative to the national rate, an observation which may account for the appreciable level of awareness.

Female↗
PubMed1997

Impact of health centre availability on utilisation of maternity care and pregnancy outcome in a rural area of Haryana.

Six hundred married women of 15-45 years age group were interviewed in 4 villages of the district Ambala in Haryana. Impact of health centre (HC) availability on the knowledge, opinion and practices related to maternity care and pregnancy outcome was assessed after adjusting the effect of socio-economic status. Except 17 women (2.8%), everyone knew at least one correct purpose of antenatal care (ANC) and 98.2% women had contacted health staff for ANC. However, knowledge of the respondents about the components of ANC was found to be poor in study villages. Traditional birth attendants (TBAs) conducted delivery in 76.1% cases in sub-centre (SC), 75.6% in villages without a HC compared to 49.8% in primary health centre (PHC) village. However, preference for TBAs in PHC village was 14.9%, in SC village 33.5%, and in villages without HC 36.3% (p < 0.001). Among respondents having better awareness about ANC components, preference and utilisation of modern delivery attendants was found to be higher. For maternity illnesses, consultation rate of government functionaries was 67.9% in PHC village, 52.2% in SC village and 55.8% in villages without a HC. Perinatal mortality rate of 76.0/1000 births in villages without HC was not significantly different from the rate of 87.4/1000 in SC village but rate of 38.9/1000 in the PHC village was significantly lower (p < 0.01). Awareness and availability of modern maternity services were found to have significant influence on the health seeking behaviour and pregnancy outcome.

Adolescent↗
PubMed1999

Repeated neonatal deaths in families with special reference to causes of death.

It is recognized that one infant death in a family indicates an increased risk of death of a subsequent sibling. This study examines which cause of death of a sibling is related to the mortality of the younger sibling and when. Longitudinal vital events data from the maternal and child health and family planning (MCH-FP) project and the comparison areas in Matlab, Bangladesh, were used. Primary causes of 868 neonatal deaths and 624 post-neonatal deaths resulting from 18,865 singleton live births in 1989-92 and those (967 as neonates and 708 as post-neonates) of their immediate elder siblings were categorised into infectious and non-infectious diseases. Multinomial logistic regression was used to estimate the risk of younger siblings dying in each age period from infectious and non-infectious diseases given the age and cause of deaths of older siblings and controlling for other biosocial correlates of infant mortality. A neonatal death of non-infectious causes in a family was twice as likely to be followed by another one occurring at the same age from similar causes compared with a surviving infant followed by a neonatal death from non-infectious causes. The MCH-FP project, though successful in reducing the risk of neonatal and post-neonatal mortality from infectious diseases, did not reduce the risk of dying from non-infectious diseases.

Bangladesh↗
PubMedDate not supplied

Fertility and contraceptive use among young adults in Harare, Zimbabwe.

In 1986, a survey of young adults aged 14-24 in Harare, Zimbabwe obtained information about their knowledge, attitudes, and sexual behavior. Most adolescent childbearing took place within marriage, although sexual intercourse was generally initiated before marriage. Knowledge of family planning was high, but contraceptive use lagged behind knowledge. Fewer than half of the respondents had talked to an elder about family planning, sex, or pregnancy. Fourteen percent of young women who were unmarried at the time of first intercourse used contraceptives, compared to 18 percent of young unmarried men. Current contraceptive use among sexually active unmarried youths was 36 percent among women and 29 percent among men. One consequence of low contraceptive use was a high number of unwanted premarital pregnancies. Twenty-nine percent of the women had been pregnant; those not married at the time they got pregnant generally got married soon after. Of the girls who got pregnant while in school, 90 percent had to drop out of school. A second consequence of low contraceptive use is an increased risk of transmission of STDs and AIDS among the youth of Harare.

Adolescent↗
PubMed1993

The determinants of use of maternal and child health services in Metro Cebu, the Philippines.

The determinants of the use of family planning, prenatal care, childhood immunizations and oral rehydration salts (ORS) were studied with survey data of 8000 women in Metro Cebu, the Philippines. Polytomous logistic regression methods were used. The level of maternal education was the most consistent and important determinant of use of these four health services in both urban and rural areas. For example, the estimated odds of using modern contraception increased by six and eleven per cent for each additional year of schooling in urban and rural strata respectively. Economic status and access to service variables had less consistent patterns: women's work status, for example, was associated only with contraceptive use.

Adolescent↗
PubMed1989

Risk groups and risk areas.

The risk approach to health management usually relates to groups of people. An alternative method is to concentrate on the areas at risk, which may sometimes be more useful in decision-making.

Health Planning↗
PubMed1992

Child survival and health care among low-income African-American families in the United States.

This paper provides an assessment and analysis of the increasing rates of mortality among the children of low-income African-American families in the United States and the intensifying problem of improper health care that seems to have given rise to it. The paper first documents the nature and determinants of the problem and then addresses the issue of policy prescriptions for eradicating the dilemma. The primary problem underlying the health-care access of low-income African-Americans is that there is neither a system of universal entitlement that ties their health care in with the rest of the population nor an explicit and comprehensive strategy for care outside the dominant private system.

Adult↗
PubMed1993

Factors related to the utilization of prenatal care in Vietnam.

Data from the 1988 Vietnam Demographic and Health Survey and 1990 Vietnam Accessibility of Contraceptives Survey were used in this analysis of the influence of selected individual and community characteristics on the utilization of prenatal care in Vietnam. Specific analysis of the impact of availability of health services and other development characteristics of the community on utilization of prenatal care was done in a rural subsample. The woman's educational level and total number of living children were the most significant predictors of prenatal care utilization. Age independent of parity did not significantly affect the use of prenatal care. Rural women and women living in provinces with the highest infant mortality rates were significantly less likely to use prenatal services than their counterparts in the urban areas and provinces with low infant mortality rates. Non-physician health care providers were the main sources of prenatal care for women in both rural and urban areas.

Adolescent↗
PubMed2001

Continuous quality assessment; development of a simple computer based model for audit.

OBJECTIVE: Accurate assessment of quality of care is a fundamental first step in the process of quality improvement. The vast amount of data generated in a hospital mandates some form of computerization for management of information. We describe a locally developed simple computer based program to access relevant information from a hospital patient management network. The objective was to reduce the amount of manual work involved for busy clinicians attempting to audit quality of care. METHODS: A single surgical procedure, Laparoscopic Cholecystectomy was chosen. Quality indicators were identified by literature review as conversion rate from laparoscopic to open cholecystectomy and length of hospital stay (LOS). A simple query was developed to extract the required information from hospital database. Commercially available spreadsheet software (Microsoft Excel) was used to calculate the rates. Outliers were defined as LOS more than 1 standard deviation from the mean. The second part of the study involved a manual review of case notes to validate the program and determine the causes for deviation from the mean. RESULTS: The program was able to access and process data as planned. In a one-year period from March 1997 to February 1998, two hundred and thirty one laparoscopic cholecystectomies were attempted. Twenty-three were converted to open procedures given a conversion rate of 9.96%. On manual review of case notes no false positives or false negatives were found. The reasons for conversion were similar to those described in the literature. The mean length of stay for laparoscopic cholecystectomy was 3.39 days and 7.17 days for converted cases. The commonest reason for delay in discharge was noted to be non-availability of elective operating time. CONCLUSION: We have successfully developed and used a simple computer based program to access information stored in hospital patient management systems. Quality of care indicators identified from literature were used as standards. Outliers with respect to these were reviewed in detail to identify causes for deviation. The program was validated by manual review.

Computer Simulation↗
PubMedDate not supplied

[Cesarean sections in Senegal: coverage of needs and quality of services].

A prospective longitudinal study was carried out of all women undergoing Cesarean section in the surgical maternity hospitals of Senegal between January 1 and December 31 1996. The epidemiology and quality of Cesarean sections were investigated. For each case, the following data were recorded: marital status, prenatal monitoring, conditions of hospitalization, indications for and outcome of surgery, maternal and neonatal follow-up one month after the operation. 2,436 Cesarean sections were performed. Of these, 2,269 cases were indexed and filed and 1,612 received a postnatal checkup one month after the operation. The mean age of the women involved was 26 years. The referral system is not effective, with 58% of patients being rushed to a surgical maternity unit in medically unsuitable forms of transport. Cesarean section is not widely available either geographically or economically. The mean national rate of Cesarean section was 0.6% of expected births but there were differences between regions. The main indications for Cesarean section were the fetus being too large to pass through the pelvic girdle (30%) and fetal suffering (18%). The maternal mortality rate was 3% and one third of the women who died did so immediately after the operation. Maternal morbidity occurred in 10% of cases, mainly due to postoperative infection. The rate of perinatal stress was 25%, most deaths being caused by neonatal distress (33%) or infection (18%). Thus, overall, both the availability and quality of Cesarean section in Senegal are poor.

Adult↗
PubMed1992

Functioning and utilization of rural water supplies in Sarawak, Malaysia.

A cross-sectional survey of 976 households in 41 villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the state of functioning and utilization of rural water supplies. The survey was carried out by inspection and interview. About one-third of the systems were functioning well, one-third imperfectly, and the remainder were no longer functioning. The coverage of households by water supply varied with the type of water supply, the overall coverage being 81.3%. Usage varied with the type of water supply and access, the overall figure being 87.1%, and the overall utilization was 70.8%. The study showed that it is important to account for water supply usage in impact evaluation because not all households have access and not all those with access use the water supply. It is also important to define water use, depending on whether the health outcome is a reduction in diseases that are water-borne or related to washing with water, because the percentage of households using the water for drinking is different from those using it for bathing.

Cross-Sectional Studies↗
PubMedDate not supplied

Abortion services in the United States, 1987 and 1988.

A 1989 survey by The Alan Guttmacher Institute shows that 1.6 million abortions were performed in the United States in 1988, a number that has remained relatively unchanged since 1980. More than 98 percent of abortions in 1987-1988 were performed in metropolitan areas. Although 51 percent of metropolitan counties have no provider of abortion services, 93 percent of nonmetropolitan counties are without a provider. The lack of abortion services in nonmetropolitan areas has been intensified by a 13 percent reduction since 1985 in the number of hospitals that offer abortion services. The number of nonhospital facilities providing abortion services increased by four percent, however, and specialized clinics provided 64 percent of all abortions performed in 1988.

Abortion, Legal↗
PubMed1996

Factors related to the initiation of prenatal care in the adolescent nullipara.

The purpose of this cross-sectional descriptive study was to explore factors that influence the timing of the first prenatal care visit of pregnant adolescents. Although researchers agree that barriers to prenatal care need to be identified and interventions formulated, barriers have not been well defined for any specific population. Increased availability and adequacy of health care resources, more family system support, and higher self-care agency scores are hypothesized to predict earlier prenatal care. A convenience sample of 51 pregnant adolescents from a university clinic was surveyed. The study found that the availability/adequacy of health care resources was the most significant predictor of the initiation of prenatal care (p = .03). Of the various health care resources assessed, only the ease in attaining a medical card was positively related to the onset of prenatal care. Practitioners can be instrumental in disseminating information about the availability of health care resources and in easing access to those resources through local and national political involvement.

Adolescent↗