Allopathic Health Research Articles

Prevalence of and factors associated with utilization of herbal medicines among outpatients in primary health centers in Cambodia

BackgroundTraditional, complementary and alternative medicine (TCAM) is seen as a way to provide healthcare in both developed and developing countries across the world. In Cambodia, there is a long tradition of using TCAM. However, scant studies have been conducted on the extent of Cambodian TCAM use and how it interacts with allopathic health care to date. In this study, we examined the prevalence of and factors associated with utilization of herbal medicines among patients with chronic diseases in primary health care settings in Cambodia.MethodsA cross-sectional survey was conducted in 2015 with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers purposively selected from Phnom Penh, Kampong Cham and Siem Reap. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. I-CAM-Q was used to measure TCAM use. A multivariate logistic regression model was constructed to identify factors associated with herbal medicine use.ResultsIn total, 1602 patients were included in this study, of whom 77.7% were female, and 51.2% were recruited from urban primary health centers with a mean age of 46.5 years (SD = 15.2). Of total, 27.0% reported at least one consultation with a TCAM provider in the past 12 months. The most common modality of TCAM used was herbal medicine (89%). Herbs were obtained at drug or folk stores (36.9%), from herbalists directly (28.5%) or from their own gardens (18.6%). Of herb users, 55.2% reported that herbs were somewhat helpful. After adjustment, herb users were significantly more likely to be female (AOR = 1.42, 95% CI = 1.12–2.67), have completed less schooling (AOR = 0.66, 95% CI = 0.45–0.96), were unemployed or homemakers (AOR = 0.23, 95% CI = 0.13–0.52) and have a gastrointestinal illness (AOR = 0.49, 95% CI = 0.39–0.62).ConclusionsHerbal medicines are broadly used among chronic disease patients in Cambodia. Understanding TCAM use in the general population will support health care practitioners and policy makers to make informed decisions about the use of TCAM. Integration of TCAM into the primary health system should be further explored.

Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa.

BackgroundTraditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism.Methods & findingsWe studied the cause of five traditional illnesses known locally as “Mavabyi ya nhloko” (sickness of the head), by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS) disorders. Participating healers were primarily female (77%), older in age (median: 58.0 years; interquartile range [IQR]: 50–67), had very little formal education (median: 3.7 years; IQR: 3.2–4.2), and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5–30). Healers reported having the ability to successfully treat: seizure disorders (47%), patients who have lost touch with reality (47%), paralysis on one side of the body (59%), and substance abuse (21%). Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR):0.47), patients who had lost touch with reality (OR:0.26; p-value<0.05), paralysis of one side of the body (OR:0.36), and substance abuse (OR:0.36) versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13–0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (~US$35) to treat substance abuse, 1000 Rand (~US$70) for seizure disorders or paralysis of one side of the body, and 1500 Rand (~US$105) for patients who have lost touch with reality.ConclusionsWhile not all healers elect to treat MNS disorders, many continue to do so, delaying allopathic health services to acutely ill patients.

Evidence-based recommendations to facilitate professional collaboration between allopathic and traditional health practitioners

Background: Globally, and in South Africa, there is an increased demand for consulting both traditional and allopathic health practitioners. As both health practitioners are working within the same communities, their respective practices could complement or undermine the health of consumers using both health services. Professional collaboration between traditional and allopathic health practitioners is therefore desirable and requires collaboration between the systems, which is currently legislated by the Traditional Health Practitioners Act 22 of 2007. However, in the Eastern Cape, no evidence-based recommendations were found that facilitated the collaborative relationship between the two health practitioner groups.Purpose of the research: To develop evidence-based recommendations aimed at facilitating professional collaboration between allopathic and traditional health practitioners for the benefit of patients.Methodology: Descriptive evidence-based recommendations to enhance professional collaboration between both groups of health practitioners were developed based on focus group interviews with allopathic practitioners (n = 10) and individual interviews with traditional health practitioners (n = 18) (traditional health practitioners (n = 14) and traditional healers who are also allopathic health practitioners (n = 4)) practising in the Amathole District in the Eastern Cape, South Africa. Dickoff et al.'s (1968) Survey List wasused as a conceptual framework.Results: Collaboration was hampered by allopathic practitioners demonstrating negative attitudes by not referring patients to traditional practitioners based on lack of knowledge and mutual understanding of each other's practices. Suggestions for collaboration made by both groups resulted in the development of two distinct sets of evidence-based recommendations.The first set of recommendations aims to enhance professional collaboration between both groups of health practitioners. This is done through facilitating mutual understanding based on respect and acceptance between the different practitioners. The second set of recommendations aims to enhance professional collaboration through facilitating open communication between different practitioners.Conclusion: These evidence-based recommendations can be used to facilitate professional collaboration between allopathic and traditional health practitioners resulting in mutual understanding and open communication, enhancing team work in a multi-professional environment, and ultimately leading to improved patient care.

Knowledge &amp; Attitude of Medical Students towards Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH)

Introduction: Amalgamation of AYUSH (Ayurveda, Yoga, Unani, Siddha& Homeopathy) with allopathy medicine is a practicable solution for scarcity of health care providers in India. In this regard Government of India has recently mainstreamed AYUSH in rural area by in cooperating it in National Rural Health Mission (NRHM). But the scope of this incorporation will be subjective to the acceptance of AYUSH by allopathic practitioners. Objective: To assess the knowledge and attitude of allopathic health care professionals (undergraduates, postgraduates and interns) towards AYUSH system of medicine. Material and Method: This was a cross-sectional study conducted in medical students of a college in Karnataka, India. Questionnaire was used and data was analyzed using SPSS 16.ver. Results: Out of 131 medical students 49% were males and 51% were females. Only 49.6% of them could expand AYUSH completely and 61% knew that AYUSH was included under NRHM. Attitude of the allopathic practitioners was positive towards AYUSH. 72.5% of them welcomed the Government move of mainstreaming AYUSH in primary health care delivery under NHM in rural areas. Conclusion: Majority of the medical students had positive attitude towards AYUSH and welcome the step of government to include them in NHM.

Evidence-based recommendations to facilitate professional collaboration between allopathic and traditional health practitioners

BackgroundGlobally, and in South Africa, there is an increased demand for consulting both traditional and allopathic health practitioners. As both health practitioners are working within the same communities, their respective practices could complement or undermine the health of consumers using both health services. Professional collaboration between traditional and allopathic health practitioners is therefore desirable and requires collaboration between the systems, which is currently legislated by the Traditional Health Practitioners Act 22 of 2007. However, in the Eastern Cape, no evidence-based recommendations were found that facilitated the collaborative relationship between the two health practitioner groups. Purpose of the researchTo develop evidence-based recommendations aimed at facilitating professional collaboration between allopathic and traditional health practitioners for the benefit of patients. MethodologyDescriptive evidence-based recommendations to enhance professional collaboration between both groups of health practitioners were developed based on focus group interviews with allopathic practitioners (n = 10) and individual interviews with traditional health practitioners (n = 18) (traditional health practitioners (n = 14) and traditional healers who are also allopathic health practitioners (n = 4)) practising in the Amathole District in the Eastern Cape, South Africa. Dickoff et al.'s (1968) Survey List was used as a conceptual framework. ResultsCollaboration was hampered by allopathic practitioners demonstrating negative attitudes by not referring patients to traditional practitioners based on lack of knowledge and mutual understanding of each other's practices. Suggestions for collaboration made by both groups resulted in the development of two distinct sets of evidence-based recommendations. The first set of recommendations aims to enhance professional collaboration between both groups of health practitioners. This is done through facilitating mutual understanding based on respect and acceptance between the different practitioners. The second set of recommendations aims to enhance professional collaboration through facilitating open communication between different practitioners. ConclusionThese evidence-based recommendations can be used to facilitate professional collaboration between allopathic and traditional health practitioners resulting in mutual understanding and open communication, enhancing team work in a multi-professional environment, and ultimately leading to improved patient care.

Allopathic and traditional health practitioners: A reply to Nemutandani, Hendricks and Mulaudzi.

An earlier paper in this journal reported on the perception and experience of 77 allopathic health practitioners (AHPs) and health managers about working together with South African traditional health practitioners (THPs). The paper stated that the abolishment of the Witchcraft Suppression Act of 1957 and the introduction of the Traditional Health Practitioners Act No. 22 of 2007 is a milestone in the development of traditional health knowledge, and for the eventual incorporation thereof into modern health care practices. The authors also comment that a decolonisation of mindset and a change of attitude is required to change one’s perception of traditional healer practices and to develop them parallel to allopathic health practice. This opinion paper is a response to the paper, to negate its claims about the Witchcraft Suppression Act of 1957 and to provide clarity on the Traditional Health Practitioners Act No. 22 of 2007 and related policies and regulations. Although this Act recognises THP, the Act and other regulations actually require THP to conform to practices analogous to those of AHP. It is rather a systematic and scientific ‘mindset’ that is required to develop THP parallel to AHP. The Traditional Health Practitioners Act of 2007 and the Draft Policy on African Traditional Medicine (TM) for South Africa dictate that a substantial THP sectoral transformation is required before there can be a parallel system. Legislation and regulations have excluded THP and African TM from operating (present and future) in the same space as AHP.

Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique

BackgroundSystematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system.MethodsAdaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients.ResultsTraditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted.ConclusionsSystematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers—an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.

Persons living with HIV infection on antiretroviral therapy also consulting traditional healers: a study in three African countries.

Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.

Quality assurance of the university medical education, hospital services and traditional pharmaceutical productsof the Bhutanese So-wa-rig-pa health care system.

BackgroundThe Bhutanese So-wa-rig-pa medicine (BSM) was integrated with the allopathic (modern) health care system in 1967. Ever since the health care integration policy was implemented, the BSM has gone through many phases of quality improvement and changes including the establishment of one university-based institute, 58 hospitals and Basic Health Units (BHU)-based health care services, and one traditional medicine factory. The BSM provides primary health care services to more than 20–30 % of patients who visit hospitals and BHU on a daily basis. However, there has been no study covering the quality assurance system of BSM. Our paper addresses this information gap.MethodsThis study was an observational ethnographic study supported by phenomenological understanding and content analysis of the data. The information was triangulated through consultation with the BSM practitioners (discussion (N = 8)) and personalized in-depth question-answer sessions using electronic protocols (N = 5). These participants comprised BSM educationists, clinical physicians, researchers, production and the quality assurance staff who were selected using convenience and purposive sampling method. The relevant So-wa-rig-pa information and literature were obtained from the government policy documents, official websites, scientific papers and the traditional medical texts. This study is enhanced by our practical observations and first-hand experience with BSM while working as the researchers at the Ministry of Health in Bhutan. In addition, the information in this paper is crosschecked and authenticated by five So-wa-rig-pa practitioners of Bhutan.ResultsThe study highlights the following: a) The BSM receives both the government and people’s support, b) The quality assurance system have been developed by integrating the traditional empirical knowledge and modern scientific protocols, c) There exist three administrative and functional organizations responsible for providing the quality BSM health care services in Bhutan, d) Extensive standard treatment guidelines and Quality documentation system exist for BSM as required by the regulatory bodies in Bhutan. The paper also recommends appropriate future directions for BSM.ConclusionsThe BSM plays significant role in the primary health care system of the country. Consequently, the quality, safety and efficacy of BSM has been given priority by the Bhutan government. Many scientific protocols were integrated with the traditional quality approaches and further scientific studies are still required to improve its quality.

Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa.

BackgroundThe indigenous health system was perceived to be a threat to the allopathic health system. It was associated with ‘witchcraft’, and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa.MethodsQualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo’s Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department’s Research Committee.ResultsDominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities.ConclusionAllopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required.

How can mental health and faith-based practitioners work together? A case study of collaborative mental health in Gujarat, India.

Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders-particularly on health improvement and livelihood restoration-and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care.

Value-Added Services in Hospitals: Does Chiropractic Care Have Economic and Marketing Impact

Chiropractic services as mainstream medicine continues to be a major debate among allopathic providers, chiropractic physicians, payers, consumers, and most health care stakeholders. It has been viewed by many as an alternative to traditional treatment for pain relief, structural manipulation for body alignment, and other acute and chronic anatomy and physiological conditions. Historically viewed by many as the outskirts of medical care, chiropractic care recently has become more prevalent among first and second choice care among consumers for certain health ailments. The evolution of complementary and alternative medicine (CAM) beginning in the late 1990’s has helped support the chiropractic profession in establishing ground to be more mainstream medicine including some claims coverage by insurance carriers. Post Patient Protection and Affordable Care Act (PPACA) America has one of its main focuses on improving primary and preventive care as well as hospital care across the United States with a purpose of reducing the overall cost of healthcare. Chiropractic care, being one of the largest CAM approaches, is certain to see changes. In this systemic review article (N=22) we will look at the role of chiropractic services in hospital settings, its funding, and potential marketing and economic value added to hospitals and the health system. The authors identify relevant literature to the research question through an exhaustive review and draw conclusions based on common factors within the literature. Hospital continues to find treatment protocols and efficiencies to reduce cost per inpatient stay. The results of this study suggest that chiropractic care can reduce cost per stay and improve health outcomes. The impact of increased integration of chiropractic services into hospital settings needs to be studied to determine long-term cost/benefit.

Allopathic and traditional health practitioners' collaboration.

BackgroundProfessional collaboration between traditional and allopathic health practitioners in South Africa is proposed in the Traditional Health Practitioners Act and could benefit and complement healthcare delivery.ObjectivesTo explore and describe the collaborative relationship between allopathic and traditional health practitioners regarding the legalisation of traditional healing, and these health practitioners’ views of their collaborative and professional relationship, as role-players in the healthcare delivery landscape in South Africa.MethodsA qualitative design was followed. The research population comprised 28 participants representing three groups: allopathic health practitioners (n = 10), traditional healers (n = 14), and traditional healers who are also allopathic health practitioners (n = 4). Purposive and snowball sampling was used. Data collection involved unstructured interviews, a focus group interview and modified participant observation.ResultsResults indicate both allopathic and traditional health practitioners experienced negative attitudes towards each other. Mutual understanding (in the form of changing attitudes and communication) was considered crucial to effective collaboration between these two health systems. Participants made suggestions regarding capacity building.ConclusionsConsidering realities of staff shortages and the disease burden in South Africa, facilitating collaboration between allopathic and traditional health practitioners is recommended. Recommendations could be used to develop strategies for facilitating professional collaboration between traditional and allopathic health practitioners in order to complement healthcare delivery.

Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India: a qualitative study.

Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour. Semi-structured and narrative interviews were undertaken with families of severely malnourished children, non-undernourished children and traditional and allopathic health-care workers. Analysis of transcripts was by qualitative content analysis. Biraul, Bihar State, India, 2010. One hundred and fifty people were interviewed in individual or group discussions during fifty-eight interviews. Undernutrition was not viewed as a disease; instead, local disease concepts were identified that described the clinical spectrum of undernutrition. These concepts informed perception, so caregivers were unlikely to consult health workers if children were 'only skinny'. Hindu and Muslim priests and other traditional health practitioners were more regularly consulted and perceived as easier to access than allopathic health facilities. Senior family members and village elders had significant influence on the health-seeking behaviour of parents of severely malnourished children. The results reaffirm how health education and CMAM programmes should encompass local disease concepts, beliefs and motivations to improve awareness that undernutrition is a disease and one that can be treated. CMAM is well accepted by the community; however, programmes must do better to engage communities, including traditional healers, to enable development of a holistic approach within existing social structures.

Engaging for-profit providers in TB control: lessons learnt from initiatives in South Asia.

There has been a huge expansion in the private health-care sector over the past two decades, particularly in South Asia, resulting in over 80% of patients seeking care from private health providers. Despite concerns about the quality and equity of private sector service provision, most government public health bodies recognize that the private sector reaches individuals that public institutions cannot cater to, thereby being important in moving closer to universal health coverage. Numerous initiatives have been launched and are being planned to involve private practitioners in effectively diagnosing, reporting and managing infectious diseases such as tuberculosis. However, there is a notable dearth of papers discussing which elements of private sector engagement strategies are more or less successful and the ethical issues that arise when engagement strategies are operationalized. This article brings together the authors' experiences of working on projects to engage private allopathic health providers in Pakistan, Bangladesh and India for improved tuberculosis control. Motivations of and strategies required to engage private allopathic heath providers, specifically doctors, diagnostic laboratories and pharmacies, and some of the ethical issues that arise when designing programmes for engagement are discussed.

Indian Health Care Professionals’ Attitude Towards Spiritual Healing and Its Role in Alleviating Stigma of Psychiatric Services

Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.

Choice of Delivery Facility among Expectant Mothers in Ghana

This article examines the effect of health insurance ownership among expectant mothers on facility-based delivery, having controlled for a host of socio-economic and demographic characteristics. Home deliveries often endanger the health of women, where complications are often referred to appropriate health facilities only when the condition has already deteriorated. Consequently, this study examines the extent to which expectant mothers’ access to health insurance influence their choice of delivery facilities broadly categorized into public health facilities, private health facilities and home delivery. Methodologically, the multinomial logistic regression is employed in the empirical estimation. Using the 2008 Ghana Demographic and Health Survey, we found at both the bivariate and multivariate level that women with access to health insurance are more likely to deliver in modern health facilities namely public and private allopathic health facilities relative to home delivery. In particular, women with access to health insurance are approximately 18 percentage points more likely to deliver in a public health facility as compared to home delivery. Also, the propensity to deliver in private health facilities relative to home delivery increases by one percentage point for women with health insurance. Thus, for expectant mothers with health insurance, the utilization of public health facilities predominates. Some of the control variables that were found to significantly influence the choice of delivery facilities include age, educational attainment, wealth quintile, area of residence, religion and region of residence. The study makes a case for scaling up access to health insurance among expectant mothers due to its positive effect on the choice of appropriate delivery facilities.

“Reaching Out to the People”: The Cultural Production of Mental Health Professionalism in the South Indian Public Sphere

AbstractAlthough a significant body of scholarship has examined medical discourse in clinical and other institutional settings, far less has been studied in regard to the discursive activity of health professionals in the public sphere. This line of inquiry is particularly relevant in Kerala, south India, where, for reasons including felt obligation, the political economy of allopathic mental health care, and desires for social prestige, many psychologists and psychiatrists actively engage the public as lecturers, authors, and guests of television and radio programs alongside their clinical work. Ethnographic attention to discursive activity in the public sphere reveals how these experts blur the boundaries between clinical and popular registers of speech and forge alternative ethical sensibilities and values that challenge institutionally prescribed ideas of clinical professionalism. They do so in ways that can attract reprobation and accusations of quackery among critical peers who hold competing ideas of where, how, and to whom mental health professionals “should” speak.

Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic

Objective : We sought to identify the percentage of nonmusculoskeletal and musculoskeletal conditions treated by interns in the National University of Health Sciences (NUHS) Student Clinic compared to chiropractic and allopathic health care professionals. Methods : The information gathered was taken from the charts of patients treated in the fall trimester, dated September 12, 2011 through December 9, 2011. The data collected included ICD-9 codes for the conditions treated, the number of patient visits, age, and gender, and was evaluated using Microsoft Excel. Results : Over half of the 113 eligible patients were women with a mean patient age of 28 years, an average of three treated diagnoses, and a mean of seven treatments. Those treated only for musculoskeletal conditions totaled 52% of the patients; 48% of the patients were treated for nonmusculoskeletal conditions, or musculoskeletal plus nonmusculoskeletal conditions. Conclusion : The NUHS Student Clinic interns are treating a greater percentage of nonmusculoskeletal conditions and a lesser percentage of musculoskeletal conditions than practicing chiropractic physicians. The student interns also treat a lesser percentage of nonmusculoskeletal and a greater percentage of musculoskeletal conditions than allopathic practitioners. This comparison would suggest that NUHS is nearing its institutional goal of training its student interns as primary care practitioners.

Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic.

Objective : We sought to identify the percentage of nonmusculoskeletal and musculoskeletal conditions treated by interns in the National University of Health Sciences (NUHS) Student Clinic compared to chiropractic and allopathic health care professionals. Methods : The information gathered was taken from the charts of patients treated in the fall trimester, dated September 12, 2011 through December 9, 2011. The data collected included ICD-9 codes for the conditions treated, the number of patient visits, age, and gender, and was evaluated using Microsoft Excel. Results : Over half of the 113 eligible patients were women with a mean patient age of 28 years, an average of three treated diagnoses, and a mean of seven treatments. Those treated only for musculoskeletal conditions totaled 52% of the patients; 48% of the patients were treated for nonmusculoskeletal conditions, or musculoskeletal plus nonmusculoskeletal conditions. Conclusion : The NUHS Student Clinic interns are treating a greater percentage of nonmusculoskeletal conditions and a lesser percentage of musculoskeletal conditions than practicing chiropractic physicians. The student interns also treat a lesser percentage of nonmusculoskeletal and a greater percentage of musculoskeletal conditions than allopathic practitioners. This comparison would suggest that NUHS is nearing its institutional goal of training its student interns as primary care practitioners.