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At least 1,027 records · Page 57Linked to original sources
PubMed1998

A qualitative assessment of the referral system at district level in Zimbabwe: implications on efficiency and effective delivery of health services.

OBJECTIVE: To qualitatively assess the referral system at district level from the consumers' point of view and assess implications it had on efficiency and effectiveness of service delivery. DESIGN: Descriptive study. SETTING: Districts of Tsholotsho and Murewa. SUBJECTS: Subjects of the study included community members, ward health team members outpatient department (OPD). MAIN OUTCOME MEASURES: The nature and magnitude of the problem; health seeking behaviour; the perceived role of a hospital versus a health centre; knowledge on the referral system; user fees and the referral system and communication between the service and the community; and perceptions on the referral system. RESULTS: The community does not know the functional differences between a hospital and a clinic. What is clearly known is the physical differences that exist between the two. That is one of the reasons why the choice of a point of entry into the health care delivery system is not always correct. People do understand the mechanics of referring a patient to higher levels of care but they were not happy with the high hospital charges. Although the majority are eligible for free treatment the issues of high transport and other indirect costs were mentioned. There is no effective communication system between the service and the users. This manifested itself through the lack of knowledge or the existence and role of ward health teams or clinic committees. This lack of communication seems to be a major determinant in the failures of many a good policy. The impact of the new fee structure of January 1994 was minimal at district level because the communities felt that although referred patients do not pay hospital consultation fees, once admitted the patient still has to pay or at least prove that he/she is eligible for free services. The inconvenience of proving eligibility for free care still exists. CONCLUSION: In general, the community did not fully comprehend the purposes and intentions of the new user fees policy of January 1994 which was meant to rationalise the referral system. Generally, communities are seldom consulted in time to ensure effective policy implementation and realisation of the intended impact. Impressions generated on the impact of the problem of the referral system on resource use at hospital level show that it has been considerable, although this study did not quantify it. Unnecessary overloading of referral centres negatively affected the care of referral cases, which actually required hospital care, due to competition with primary care cases.

Adult↗
PubMedDate not supplied

Social context of human immunodeficiency virus transmission in Africa: historical and cultural bases of east and central African sexual relations.

The literature relating to the social context of sexual relations in East and Central Africa has several implications for the heterosexual transmission of human immunodeficiency virus (HIV). Colonially created cities in the region still discriminate economically and socially against women. Rapid urbanization is occurring, but migrants maintain strong ties with rural areas. Traditional attitudes towards marriage and sexuality affect urban behavior in the extent of marital stability, the frequency of polygyny, and the emotional bond between spouses. Ethnic groups in Kampala and Nairobi exemplify the cultural foundations of two forms of sexual relations found in the region, one characterized by prostitution and the other by small circles of interchanging lovers. The first results in a more rapid spread of HIV through the urban population and outwards into rural areas. Each pattern exerts unique constraints on behavioral change and requires different prevention campaigns.

Africa, Central↗
PubMed1992

Infant mortality and crisis in Mexico.

Data derived from the Encuesta Nacional de Fecundidad y Salud (ENFES) confirm that overall levels of infant mortality in Mexico have been steadily declining. However, a more specific analysis furnishes evidence that this decline has occurred at varying rates within different social groups, reflecting an increase in social inequalities. The analytical strategy used in this article leads to three basic conclusions: (1) the impact of the economic crisis on infant mortality is reflected not in a reversal of the declining trend but an increase in social inequalities; (2) certain variables universally accepted as determinants of infant mortality, such as mother's education, seem nonsignificant for some social sectors; and (3) certain biodemographic characteristics assumed to have a uniform mortality-related behavior vary among sectors, suggesting that even these constants are determined by social factors.

Educational Status↗
PubMed1985

[Simulation of possible developments in urbanization in the German Democratic Republic by the use of a multi-regional population model].

An attempt is made to forecast likely trends in urbanization in the German Democratic Republic over the next 50 years using the multi-regional approach developed at the International Institute for Applied Systems Analysis in Laxenburg, Austria. "Three scenarios describe possible variants in the changes of fertility, mortality and interregional migration as demographic factors. The term 'region' is applied to 4 sizes of communities each grouped as rural communities, small towns, small medium-size towns, and large medium-size towns/large towns. The results of the simulation indicate for all three scenarios an absolute and relative decline in population of the rural communities and a continuation of the process of concentration among the population." (summary in ENG, RUS)

Demography↗
PubMed1995

Confinement of winter birth excess in schizophrenia to the urban-born and its gender specificity.

BACKGROUND: The season of birth phenomenon in schizophrenia was reexamined in relation to place of birth, in order to test the hypothesis that a seasonal factor might operate preferentially among those who were urban-born. METHOD: The seasonal distribution of births was examined among 3253 patients in two case registers having an ICD-9 diagnosis of schizophrenia and compared with the distribution of births among the normal population born in those catchment areas over the same period; those subjects born in population centres greater than 50,000 were defined as urban-born. RESULTS: Patients who were urban-born showed an excess of winter births relative to controls that was absent among their rural-born counterparts. On comparing patient groups, those who were urban-born were more likely to be born in the winter, while those who were rural-born were more likely to be born in the spring; this urban-rural distinction was confined essentially to female patients. CONCLUSIONS: These findings might be accommodated most readily in terms of a spatially as well as seasonally varying environmental factor that is associated with urbanicity and to which female offspring are more vulnerable.

Adult↗
PubMed1983

On some faulty concepts in Soviet urban studies.

"The authors attack what they call 'superurbanism' and 'agglocentrism,' an excessive preoccupation among some Soviet geographers with urbanization and the formation of urban agglomerations. The authors advocate what is known in Soviet geography as a 'unified system of settlement,' meaning a harmonious blend of both urban and rural forms. The 'agglocentrists' are said to derive their ideas from Western models, and the authors [note the growing] disenchantment with excessive urbanism in the West."

Demography↗
PubMed1980

[Urbanization and development of the urban population in the German Democratic Republic].

The authors present evidence that "urbanisation in the GDR [German Democratic Republic] has considerably increased within the last 30 years though statistically the urban population has only slightly grown. Urbanisation is seen as a socio-economic process, as a stage-by-stage transition from the rural to the urban way of life. The socialist changes led to a spread and consolidation of the urban way of life. With the population trend stagnant, there are long-term regional concentration processes apparent, marked by the further development and a more equal distribution of large and medium towns." (SUMMARY IN ENG, RUS)

Demography↗
PubMed2004

Small-area incidence trends in breast cancer.

BACKGROUND: During the past 2 decades, the observed incidence of in situ and early-stage invasive breast cancer has increased substantially as a result of increased use of mammography. Geographic variability in the increase in breast cancer incidence has been observed among large areas. Examining the variability among small areas in the incidence over time will facilitate appropriate geographic allocation of resources aimed at increasing screening. METHODS: We examined county-specific increases in breast cancer incidence over time, specifically the variability and spatial correlation in the increase in breast cancer incidence. The analyses were based on county-level data (1973-1997) from the Iowa Surveillance, Epidemiology, and End Results program. A spatiotemporal hierarchical Bayesian model was used to examine variability in county-specific rates (intercepts, slopes, and spatial correlations) among white women at least 40 years of age. RESULTS: Posterior values indicate there was little variability among counties in the change in breast cancer incidence over time (slope) but substantial variation among intercepts. There was considerable spatial correlation among the county-specific intercepts but a lack of a spatial correlation among the county-specific slopes. There was no correlation between the county-specific intercept and slope. CONCLUSIONS: Breast cancer incidence increased over time, but county-specific rates increased independently relative to their neighboring counties or their initial rate.

Adult↗
PubMed1993

Factors responsible for childhood mortality variation in rural Ethiopia.

This paper uses the 1981 National Rural Demographic Survey to document childhood mortality variations in rural areas of Ethiopia. Four significant findings are highlighted. (1) Health status of parents is identified as an important determinant of childhood mortality. (2) Religion, region of residence and ethnicity interact in their effects on childhood mortality and the effect of ethnicity varies in different regions for the same religion; in some areas ethnicity may serve as a proxy for economic and cultural differences. (3) Childhood mortality is inversely related to literacy status of parents, which may also reflect socioeconomic status. (4) The data show a clear difference in childhood mortality between the famine-prone areas and the rest.

Adult↗