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PubMedDate not supplied

Prescription patterns and cost analysis of drugs in a base hospital in south India.

BACKGROUND: In the rural areas of developing countries the cost of drugs is a major concern to both physician and patient; yet there are few data on prescribing patterns and expenditure. We examined the cost of commonly prescribed drugs in a community health care programme in a base hospital of the Christian Medical College, Vellore. METHODS: The study was carried out over a period of 3 months during which 2756 prescriptions were analysed. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. RESULTS: The number of drugs prescribed for each patient ranged from 1 to 7 with a mean (SD) of 2.4 (1.1). The most commonly prescribed groups of drugs were vitamins, analgesics, antibiotics, sulphonamides and anti-inflammatory agents. The mean (SD) cost per prescription was Rs 8.8 (8.6). The expenditure on the most commonly used drugs was approximately 50% of the total cost. The cost per prescription was less than Rs 10 in 70% of the cases. All the drugs were from the World Health Organization's essential drugs list. CONCLUSIONS: Most prescriptions for drugs given at our hospital could be afforded by villagers.

Costs and Cost Analysis↗
PubMed1993

Air pollution and pollen allergy.

Pollen allergy is the most typical form of allergic diseases. The increase in its frequency during recent years is most evident. The disease was rare when it was first described 150 years ago as summer hay fever. In 1876 Blackley wrote that the frequency of pollen allergy was increasing, especially in industrialized countries. Nowadays the prevalence of pollen allergy is well above 10%. Among the patients predominate the inhabitants of large cities, but not rural residents. Allergy develops as a result of multiple interactions between the human immune system and the environment. The current state of knowledge does not permit precision about the importance of genetic and environmental factors. It appears that although genetic control is very important, the environmental influences seem most important in determining the specific allergens to which a person will develop hypersensitivity. The adjuvant factors of the environment play an important role in the increasing problem of pollen allergy in large cities. Air pollution such as sulphur dioxide, ozone, nitrogen oxides, occupational dust, organic and inorganic suspended particulate matter, tobacco smoke, etc., can cause an increase in airway reactivity through mechanisms dependent on or independent of specific IgE antibodies. By irritating the airways and skin, pollen grain penetration into the human body can increase. Defective permeability of tissue surface can increase the risk of infection. Air pollution may also increase the development of pollen allergy through a direct influence on the pollen grains (on their enzymes, plant growth etc.). Lastly, the pollen grains may carry on their surfaces the various substances which are known as environmental allergens.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollution↗
PubMedDate not supplied

[Obesity. Its medico-surgical treatment].

Obesity has been defined as excessive deposition of body fat tissue that risks the health and survival of the patient. It affects almost 30 per cent of whole population in western societies and it's also becoming a common problem in developing countries as rural areas are slowly decreasing in face of urban growing. In Mexico obesity affects as much as 28 per cent of the population of selected urban areas and the trend seems to follow the incidence in North America. There are genetic, environmental, physiological, psychological, social and cultural factors that determine or influence the presence of obesity in modern societies. To date the most accepted approach to the management of this problem lays on 3 main aspects: diet, exercise and behaviour modification. Pharmacological therapy should be limited to selected cases in which associated clinical risks warrant more urgent intervention. Surgical therapy is indicated for morbid obesity in which there is greater than 70 per cent excess weight. Prevention of obesity should remain one of the top priorities in public health and should take genetic, physiological, environmental, social, psychological, cultural and economic factors into consideration.

Adipose Tissue↗
PubMedDate not supplied

Making health services more accessible to younger people.

High rates of teenage pregnancy and the demands of younger people for more accessible health care were the driving forces behind a series of initiatives to develop more appropriate services. The developments in a rural area of Tayside involved inter-agency working and young people's ongoing involvement.

Adolescent↗
PubMed1995

Age and religion selection biases in HIV-1 prevalence data from antenatal clinics in Manicaland, Zimbabwe.

Sera from 487 women attending antenatal clinics in two areas of Manicaland were tested for the presence of HIV-1 infection. In the Honde Valley and Rusitu Valley areas, 24,3 pc and 14 pc respectively, were found to be infected. HIV-1 infection was found to be associated with age, marital status and location. Younger women, non-married women and women living in the Honde Valley were all more likely to be infected. There was also a weak association with level of education, with women with secondary education being at greater risk of being infected. The unadjusted overall figures for HIV-1 prevalence from the antenatal clinics were shown to provide a poor indication of the relative levels of prevalence of infection in the two study areas because of differences in the age structure and religious affiliations of the antenatal clinic and study populations. Similar problems may exist in sentinel surveillance data and would distort comparisons between locations and over time, especially during periods of rapid fertility change. In particular, the age bias is liable to exaggerate differences between urban and rural populations in developing societies. Where comparable information is available for the general population and sample sizes permit, this problem may be overcome by collecting basic socio-demographic data on the individuals tested and then applying standardization techniques. In the Honde Valley and Rusitu Valley example, the levels of HIV-1 prevalence after adjusting for age differences are 18,4 pc and 13,2 pc respectively.

Adolescent↗
PubMed1998

Immunizations for international travelers.

Each year more than 45 million Americans travel abroad for work or pleasure, and over 20 million of these travel to rural areas or developing countries. While the major medical risks of international travel are often exaggerated, the incidence of minor illness is not. Persons going to Asia, Africa, or Latin America for one month run a 65% to 75% chance of becoming ill, although only 1% will require hospitalization. The two most common illnesses that affect travelers, which do have immunizations and are often overlooked by physicians, are influenza and hepatitis A. The risk of illness to the traveler varies by health and age status, by the region to be visited, by the time of year, and by the length of the journey. Immunization advice for the traveler, therefore, is complicated and is best approached in a systematic manner. This article outlines six steps to sound immunization advice. These steps include ascertaining the traveler's special individual needs, routine immunization status, and routine travel immunization status, as well as the entry requirements for the country to be visited, geographically indicated vaccines, and immunizations as indicated for extended stays abroad.

Adult↗
PubMed2005

Market transition, educational disparities, and family strategies in rural China: new evidence on gender stratification and development.

Two theoretical perspectives have dominated debates about the impact of development on gender stratification: modernization theory, which argues that gender inequalities decline with economic growth, and the "women in development" perspective, which argues that development may initially widen gender gaps. Analyzing cross-sectional surveys and time-series data from China, this article indicates the relevance of both perspectives: while girls' educational opportunities were clearly more responsive than boys' to better household economic circumstances, the era of market transition in the late 1970s and early 1980s failed to accelerate and, in fact, may have temporarily slowed progress toward gender equity.

China↗
PubMed1995

Essential drugs for ration kits in developing countries.

Since the early 1980s drug ration kits have been used to improve the supply of essential drugs to rural health facilities in developing countries. This paper evaluates some of the experiences with kit systems in Angola, Bhutan, Democratic Yemen, Guinea-Conakry, Kenya, Mozambique, Sudan, Tanzania, Uganda and Zambia in relation to the selection of drugs for the kits and their quantities and cost. Data were collected through a review of published papers, annual reports and programme evaluations, by questionnaires among field staff and interviews with key experts. In comparing the 10 programmes, 21 drugs can be identified that are used in at least two-thirds of all kits. This list may be useful for evaluation and planning purposes. Six drugs (ORS, chloroquine and 4 antibiotics) usually account for over 60% of the cost of the kit. Careful monitoring of the price and quantities of these 6 drugs can therefore be very cost-effective. In the absence of reliable data on morbidity and drug needs in the initial phases of a kit system, the median drug quantities in kits from these 10 countries may serve as a starting point. Accumulating surpluses are sometimes perceived as a serious disadvantage of kit systems, ORS, benzylbenzoate solution and iron tablets are the three drugs that have most frequently accumulated. These drugs are relatively cheap and usually have a long shelf-life; in most programmes they have been successfully redistributed to other health facilities while the kit content was being adapted. The overall financial loss due to accumulation of surpluses is therefore limited. Most programmes have reached a stable kit content within two years.

Ambulatory Care Facilities↗
PubMed1993

Women's labour force participation and socioeconomic development: influences of local context and individual characteristics in Brazil.

We address several key hypotheses about the effects of socioeconomic development on women's labour force participation during the transition from agriculture to industrialism. To this end, we explore differences in women's labour force participation in Brazil by education, marital status, age, and urban or rural residence. We also show how socioeconomic development affects the overall level of women's participation and the differentials by education, etc. Our data are drawn from a large 1973 PNAD (Pequisa Nacional por Amostra de Domicilos) survey conducted by the Brazilian census bureau. Socioeconomic development in different parts of Brazil ranges from pre-industrial agriculture to heavy industry. Using logistic regression, we show that the general level of women's labour force participation does not change with the level of development. Highly educated women are much more likely than the less educated to be in the labour force (net of other influences); this difference is substantially greater than in post-industrial societies. Somewhat surprisingly, the influence of education is the same across the range of development levels in Brazil. Single women are more likely to be in the labour force than married women, and the difference grows during development. Age has a curvilinear relationship to labour force participation, and the old are much less likely to participate in more developed places. Rural women are slightly more likely to be in the labour force at all levels of development.

Adolescent↗
PubMed2002

Prevalence and correlates of late-life depression compared between urban and rural populations in Korea.

BACKGROUND: The aetiology of late-life depression has received relatively little research in developing countries. Urban and rural populations have rarely been sampled in the same study. OBJECTIVES: To investigate demographic factors associated with depression and depressive symptoms in an urban and rural sample of older Korean people. METHODS: A community survey of residents aged 65 or over was conducted in an urban and a rural area within Kwangju, South Korea. The Korean Form of the Geriatric Depression Scale (KGDS) was administered. Associations with demographic, socio-economic factors and cognitive function (MMSE) were investigated for depression categorised according to a previously validated cut-off. RESULTS: The sample comprised 485 urban-dwelling and 649 rural-dwelling participants. No difference was found between urban and rural samples for prevalence rates of depression. However associations with independent variables varied between the areas. In the urban sample, increased age, low education, manual occupation and current rented accommodation were independently associated with depression. Only low education was associated with depression in the rural sample. The interaction with sample area was strongest for age (p < 0.01) and persisted after further adjustment for cognitive function. CONCLUSIONS: Adverse socio-economic status was strongly associated with depression and appeared to operate across the life-course. While no evidence was found for urban-rural differences in prevalence rates of depression, factors associated with depression differed between these populations.

Aged↗
PubMed1994

Community-based survey versus sentinel site sampling in determining the nutritional status of rural children. Implications for nutritional surveillance and the development of nutritional programmes.

A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of KwaZulu by means of a representative community-based sample and concurrent samples from primary health care clinics, preschools and primary schools. The first objective of this exercise was to determine the extent of acute nutritional stress in the district as an indication of the appropriateness of food relief efforts in the region. The absence of wasting and the high prevalence of stunting (37.5%) in the community-based sample suggested that the main problem is chronic socio-economic underdevelopment, rather than a severe or immediate lack of food. The fact that fewer than 20% of households are in any way reliant on domestic production for their maize requirements explains why the recent drought has not had a greater impact on the nutritional status of this vulnerable group. This study confirms that the more recent emphasis of the National Nutrition and Social Development Programme on social development is appropriate. An equally important objective of this study was to evaluate the usefulness of clinics, preschools and schools as sites for the collection of anthropometric data and the development of nutritional programmes. This preliminary attempt to develop the methodology for district-based nutrition surveillance suggested that all these sites have limitations both in respect of data collection and community access. The implications of using these sites and the developments needed to improve their usefulness in a future nutrition surveillance system are discussed.

Anthropometry↗
PubMed1999

Can community organization strategies be used to implement smoking and dietary changes in a rural manufacturing work site?

A one-year intervention project was developed and implemented to demonstrate the utility of using community organization methods to mobilize a rural, predominantly minority work site community toward smoking and dietary change. This intervention for smoking and dietary change was conducted in a rural work site (n = 235 at baseline) and guided by employees. It involved activities to change the work site environment and the behaviors of individuals. A community advisory board (n = 15) made up of members of the work site was established, and it met monthly with members from the research team to design and implement nine cancer prevention activities that were targeted to the needs of this community. Activities and information were disseminated to the employees during a nine-month period. Surveys were administered prior to and following the delivery of the intervention. This project was successful in engaging a rural manufacturing work site community in thinking about cancer prevention strategies. Results of this intervention demonstrated significant increases in numbers of smoking cessation attempts, reported fruit and vegetable consumption, self-efficacy for dietary change and perceived risk for cancer. Work site social norms changed as evidenced by employee perceptions of co-worker support of dietary and smoking change (all ts > 1.95, all Ps < 0.05). Other results with marginal statistical significance (P < .015) but potentially useful for future studies include increased intentions to reduce the fat in the diet. In light of the low-intensity and time-limited nature of this community organization intervention, the observed changes in dietary and smoking behaviors are encouraging and support the use of these strategies in rural, culturally diverse work sites.

Adult↗
PubMed1993

When more means less: assessing the impact of dairy 'development' on the lives and health of women in rural Rajasthan (India).

Following upon the proclaimed success of cooperative dairy schemes in other parts of India (Operation Flood based on the Amul model), the Rajasthan government is attempting a similar scheme. A key theme of the project is to bring women into the mainstream of dairy development in order to improve their economic, nutritional, and social status. For this purpose a special program was initiated to train poor rural women in 'dairy camps' on how to care for their milch animals. Successful completion of such 'camp' training then qualifies the woman for a loan to buy an animal in her name. It is hoped that a part of the milk obtained will go to the village dairy cooperative. The major aims of this program are to: remove milch animals from the cities; encourage production of more milk for the cooperative dairies; encourage modern techniques of animal care; put control of the income from milk-selling in the hands of the women who care for the animals by permitting them to own the animals and hence contribute to their 'independence' and 'development;' and to encourage self-sufficiency for the weaker sections by providing loans to the poor. Data for this paper were collected during fieldwork in a village in Alwar District, Rajasthan and specifically from observation and participation in the two-week dairy 'camp' there. Eighteen women were selected on poverty criteria to participate in the program. The general situation of these women is analyzed within the context of a critical discussion of the dairy movement in India, in general, and the intended effects on the lives of the village women, in particular, with special attention to the impact on their workload, nutritional intake and, ultimately, overall health. Concluding remarks are addressed to the broad issues of government development programs and why more of the same type of development strategies persist in the face of often-repeated failures.

Dairying↗
PubMed2004

Choosing to practice in rural dietetics: what factors influence that decision?

OBJECTIVE: The present study aimed to identify those factors that influence the decision of a dietitian to consider working in a rural area. DESIGN: A qualitative design using focus groups was chosen for this study to allow for in-depth data to be obtained. SETTING: University of Newcastle, Callaghan Campus. SUBJECTS: Twenty-three students/new graduates from the Bachelor of Health Science (Nutrition and Dietetics) degree at the University of Newcastle. MAIN OUTCOME MEASURES: Not applicable, this project was an exploratory study. RESULTS: A number of factors that influence the decision of dietetic students and newly graduated dietitians to consider working in a rural area were identified. These fell into the following main thematic areas: job prospects; rural lifestyle; comfort zones; support networks; promotion opportunities/professional development; type of work/work role; rural needs; and time frame. CONCLUSIONS: The present study found that choosing a location to work (whether it be a rural one or not) is a complex process and involves a number of interacting factors. Also those factors that may influence one dietitian to choose a career in a rural area may also be the factors that influence another dietitian not to choose a career in a rural area.

Attitude of Health Personnel↗
PubMed2001

Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study.

OBJECTIVE: To measure the effects of iron supplementation and anthelmintic treatment on iron status, anaemia, growth, morbidity, and development of children aged 6-59 months. DESIGN: Double blind, placebo controlled randomised factorial trial of iron supplementation and anthelmintic treatment. SETTING: Community in Pemba Island, Zanzibar. PARTICIPANTS: 614 preschool children aged 6-59 months. MAIN OUTCOME MEASURES: Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups. RESULTS: Before intervention, anaemia was prevalent and severe, and geohelminth infections were prevalent and light-Plasmodium falciparum infection was nearly universal. Iron supplementation significantly improved iron status, but not haemoglobin status. Iron supplementation improved language development by 0.8 (95% confidence interval 0.2 to 1.4) points on the 20 point scale. Iron supplementation also improved motor development, but this effect was modified by baseline haemoglobin concentrations (P=0.015 for interaction term) and was apparent only in children with baseline haemoglobin concentrations <90 g/l. In children with a baseline haemoglobin concentration of 68 g/l (one standard deviation below the mean value), iron treatment increased scores by 1.1 (0.1 to 2.1) points on the 18 point motor scale. Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura, but not by hookworms. Mebendazole increased development scores by 0.4 (-0.3 to 1.1) points on the motor scale and 0.3 (-0.3 to 0.9) points on the language scale. CONCLUSIONS: Iron supplementation improved motor and language development of preschool children in rural Africa. The effects of iron on motor development were limited to children with more severe anaemia (baseline haemoglobin concentration <90 g/l). Mebendazole had a positive effect on motor and language development, but this was not statistically significant.

Anemia, Iron-Deficiency↗
PubMed1990

HIV/AIDS prevention: problems and approaches to establishing needle exchange programs in rural areas.

Needle and Syringe Exchange Programs (NSEP) were established to prevent the spread of HIV/AIDS amongst intravenous drug users (IVDU). The first rural NSEP in Australia was developed in the North Coast Region of NSW. The aims and objectives of the NSW NSEP are outlined. The problems and approaches faced by health services managers in developing a needle exchange program in a conservative rural area are presented with the emphasis on 4 major groups: intravenous drug users; the media; the general community and the public health system. A brief description of the North Coast NSEP, which is a combination of fixed outlets and outreach work, is presented. During 1989, there were 4,000 direct client contacts with 65,000 needles/syringes dispensed and 45,000 collected (69% return rate) for contaminated waste disposal.

Acquired Immunodeficiency Syndrome↗