Clinics In Rural Areas Research Articles

Out-of-pocket expenditures on traditional and Western medicine in Taiwan

Coexistence of traditional and modern medicine is common in Asian countries. This paper investigates out-of-pocket expenditures on traditional medicine, traditional medical service, and Western medicine by households in Taiwan. Using a national sample of 13,765 households, the three expenditure equations are estimated with a censored system procedure. Effects of socio-demographic variables are explored by calculating marginal effects on probabilities and levels of medical expenses. Different types of medical expenditures are correlated. Households with higher income and more aging members use more traditional medicine than others, as do households in agricultural sector and in urban areas. In addition, households living in rural areas relative to those in the cities are more likely to use and also spend more on traditional service. Regional disparity of health care utilization is found. Higher income households spend more on traditional medicine, likely due to the fact that patients usually pay out-of-pocket for herbal materials needed in preparation of traditional medicine. To ensure equity in health care utilization, establishment of hospitals and clinics in rural areas should be considered.

Drug prescribing indicators in village health clinics across 10 provinces of Western China

The irrational use of drugs was a global problem, especially in developing countries. However, there are no studies available on irrational use of drugs in rural Western China. To assess the drug prescribing patterns using World Health Organization Drug Use Indicators at village health clinics in rural areas of Western China. A total of 20 125 prescriptions were collected from 680 primary health clinics in villages from 40 counties in 10 provinces of Western China. Five measurements were used to assess the irrational drug use: percentage of encounters with an antibiotic prescribed, average number of drugs per encounter, percentage of encounters with an injection prescribed, percentage of drugs prescribed by generic name and percentage of drugs prescribed from National Essential Medicines List or Formulary. Index of Rational Drug Prescribing (IRDP) was used as an indicator of rational drug use. The percentage of prescriptions containing antibiotics was 48.43%, while the average number of drugs per prescription was 2.36, and the percentage of injection prescriptions was 22.93%. The percentage of drugs prescribed by generic name was 64.12%, and the percentage of drugs prescribed from the National Essential Drug List was 67.70%. The IRDP of the present study was 3.32 with the optimal level of 5. There are also some regional variations in these measurements. The study provides some evidence of irrational use of drugs to a great extent in rural areas of Western China. Overuse of injection and overuse of antibiotics were the most prominent manifestations of such irrational drug prescribing.

Beyond silence and rumor

PurposeThis paper aims to explore the role of a small‐scale project around storytelling as a form of informal education in five health clinics in rural areas of the Limpopo Province in South Africa. The aim of the project is to decrease the stigma around HIV/AIDS and to start an open dialogue in local communities about the disease.Design/methodology/approachThis is an exploratory study using a qualitative approach, which was carried out in 2005/2006, that focused on perceptions of participants from the audience of the project and health practitioners.FindingsThe research findings emphasize the importance of involvement of a storyteller who can play an influential role in local rural communities by breaking the stigma attached to HIV/AIDS and providing people with little or no education with simple but effective messages about the disease. Stories are embedded in local traditions and make use of metaphors, like dialogues between animals. Beside, stories are a form of “edutainment”: education enriched with entertainment.Research limitations/implicationsOwing to budgetary and time constraints insight into the impact of the project on the way the members of the audience protect themselves and deal with the essential issues of sexuality and relationships in their daily life as a result of storytelling was not gained.Originality/valueOwing to its personal approach a project around storytelling in rural areas in South Africa is vital, because it seems to suit the local context better than nationwide health educational programmes which are normally disseminated through mass education.

Costing Dental Restorations in Public Sector Dental Clinics

The objective of this study is to share cost analysis methodology and to obtain cost estimates for posterior restorations in public sector dental clinics. Two urban and 2 rural dental clinics in Selangor state were selected. Only cases of 1 posterior restoration per visit by dental officers were included over 6 months. One capsulated amalgam type, 1 capsulated tooth-colored, and 1 non-capsulated tooth-colored material were selected. A clinical pathway form was formulated to collect data per patient. Annual capital and recurrent expenditures were collected per clinic. The mean cost of an amalgam restoration was RM 30.96 (sdRM 7.86); and tooth-colored restorations ranged from RM 33.00 (sdRM 8.43) to RM 41.10 (sdRM 10.61). Wherein 1 USD = RM 2.8. Restoration costs were 35% to 55% higher in clinics in rural areas than in urban areas. The findings demonstrate economy of scale for clinic operation and restoration costs with higher patient load. Costs per restoration were higher in rural than in urban dental clinics. More studies are recommended to address the dearth of dental costs data in Malaysia.

Ecologic Correlates of Obesity in Rural Obese Adults

Objective: We examined relationships of individual and environmental factors with obesity and trying to lose weight in rural residents.Methods: The joint contributions of individual and environmental factors on obesity status (obese vs. morbidly obese) and trying to lose weight (yes vs. no) were evaluated using generalized estimating equations. Patients at 29 clinics in rural areas (N = 414, M age 55.0 years (SD = 15.4), 66.3% female) completed anthropometric assessments of weight and height along with survey assessments of individual sociodemographics and trying to lose weight. Rural environments were assessed on aggregated physician access, and sociodemographic context.Results: Most participants (70%, M BMI = 38.3) were obese and 30% morbidly obese. A majority (73%, n = 302) of the sample was trying to lose weight. Compared to obese, morbidly obese participants were more likely to be younger, disproportionately female, not have private insurance, have more comorbid conditions, and rate themselves in worse health in comparison to their obese peers. Compared to not trying to lose weight, trying to lose weight participants were more likely to be younger, disproportionately female, have fewer comorbid conditions, and have attempted to lose weight more times through exercise. Few relationships were seen between environmental variables and obesity or trying to lose weight.Conclusions: There was no consistent pattern of relationships between environment factors and obesity or trying to lose weight was seen. Unique aspects of rural living may not be captured by traditionally available neighborhood measures.

Evolution of telepsychiatry to rural sites: changes over time in types of referral and in primary care providers' knowledge, skills and satisfaction

Introduction Rural populations remain underserved in terms of psychiatric services. This study assesses changes over time in the utilization of telepsychiatric services by individual primary care providers (PCPs) and clinics in rural areas, specifically: (a) types of referrals for telepsychiatry service; (b) PCPs' knowledge and skills related to medication dosing; and (c) PCPs' satisfaction with telepsychiatry. Methods Data with regard to patient demographics, diagnoses, reason for consultation, medication dosing and satisfaction were prospectively collected on the first 200 and the subsequent 200 telepsychiatric initial consultations. A number of educational interventions were implemented during the project. Results Adult patients were primarily referred for mood and anxiety disorders, particularly for diagnosis and medication treatment planning. Over time, PCPs significantly improved medication dosing and asked for more treatment planning help. PCPs' satisfaction also improved over time. Discussion Telepsychiatric consultation, in combination with specific educational interventions, appears to facilitate the enhancement of skills and knowledge of PCPs. “Developmental” steps in provider and clinic evolution, along with interventions specific to a given provider's and a given site's needs, ought to be further elucidated.

Malaria Vector Heterogeneity in South America

All South American countries except Chile and Uruguay currently experience transmission of human malaria, which is one of the commonest maladies treated at health clinics in rural areas (Fig.l). Annual parasite indices, the numbers of malaria infections per thousand persons, for 1997 ranged by country from 0.4 in Paraguay to 314.5 in Suriname (PAHO 1998). More than one-half of the slightly less than one million annual registered cases occur in Brazil, with Peru and Colombia following in numerical importance (PAHO 1998). Although the majority of infections are of Plasmodium vivax (Grassi & Feletti), P. falciparum (Welch) and P. malariae (Grassi & Feletti) may be abundant locally (e.g., Branquinho et al. 1993, Arambarú Guarda et al. 1999).

Starting mental health services in Cambodia

Cambodia has undergone massive psychosocial trauma in the last few decades, but has had virtually no western-style mental health services. For the first time in Cambodia a number of mental health clinics in rural areas have been started. This experience is used to discuss the risks and opportunities in introducing these services in the present war-torn situation. Basic statistics from the clinics are presented in the context of the historical and traditional setting, and the effort to maintain a culturally informed approach is described. The contrasting results in the clinics are analyzed in relation to factors intrinsic to the health care system and those related to the local population in order to highlight the issues involved in establishing future mental health services, both locally in other provinces and in situations similar to Cambodia. The efficacy of introducing low-cost, basic mental health care is shown, and related to the need to find solutions for prevailing problems on the psychosocial level. They can be introduced with modest means, and can be complementary to local health beliefs and traditional healing. In introducing mental health services, an approach is needed which adapts to the absorption potential of the health system as well as to the patients' need to find meaningful help. Existing resources, from the traditional healing sector to rudimentary village structures, cannot be neglected in the rehabilitation of the community, or in interventions to help the individual patient.

A diagnostic study of photovoltaic systems at rural health centres in Guyana

Several standalone photovoltaic systems were installed, between 1983 and 1991, to provide lighting and vaccine refrigeration at health clinics in rural areas of Guyana. This paper reports on the results of a diagnostic survey of these units. This exercise was done in 1994 and it was aimed at assessing the scope and nature of the servicing or rehabilitation works that were necessary to restore the operational levels of the photovoltaic systems.

Health care delivery to farmworkers in the Southwest: an innovative nursing clinic.

The migrant and seasonal farmworkers of the United States constitute a medically underserved population with many health care needs. Barriers to health care among farmworker families include financial constraints, cultural factors, restrictive labor practices, and absence of accessible clinics in rural areas. The Migrant Health Outreach Program is a federally funded mobile nursing clinic created to deliver health care to farmworkers where they live and work. The Migrant Health Outreach Team, composed of family nurse practitioners, registered nurses, and health care workers, offers primary care including health care maintenance and treatment of acute and chronic illness. The mobile nursing clinic serves the target population of farmworkers as a successful alternative to a traditional medical clinic.

Family-planning clinics and educational programmes--a rural experience.

Although family-planning clinics are numerous and well-accepted in most Australian capital cities, such clinics have been difficult to establish in some Victorian rural towns. One such clinic was established at a rural base hospital in a Victorian town in 1984. The history of the clinic's development and its mode of operation are discussed. The profiles of 157 consecutive new patients who attended the clinic are presented. Comparisons are made with the patient profiles from a Melbourne family-planning clinic. The clinic also provides a separate weekly educational programme. The effect of the educational service in attracting patients to the clinic also was evaluated. Over all, it was concluded that the successful establishment of this clinic has been a result of the appointment of female medical and nursing staff members, the support of the local base hospital, an active media campaign and the development of a separate and concurrent educational programme that was conducted by clinic staff members. It is recommended that these factors be considered in the future development of such clinics in rural areas.

A Clinical Study of Norethisterone Enanthate in Rural Mexico

Clinical trials of norethisterone enanthate (NET-EN), a long-acting, injectable progestogen, have demonstrated its short-term safety and effectiveness as a method of contraception in a controlled trial setting. Family planning programs interested in providing NET-EN need information on its efficacy and acceptability under usual field conditions. This first field study of NET-EN was conducted in family planning clinics in rural areas of Mexico. Women admitted to the study were followed up at two-month intervals to receive an injection of 200 milligrams of NET-EN, and to be asked about possible side effects of the drug. Among the 5,792 women recruited, the overall life-table discontinuation rate was 57.0 per 100 women at 12 months and 69.0 at 18 months. The single most common reason for discontinuation was amenorrhea, followed by bleeding problems. Women who were older and who already had several children were most likely to continue using NET-EN. Nine pregnancies were reported during the study, with a cumulative pregnancy rate of 0.3 per 100 women at 18 months. NET-EN appears to be an effective method of contraception that is acceptable to a substantial proportion of women from rural areas in Mexico who choose to use it, when it is provided through a national family planning program.

Growth of Guyanese infants of African and East Indian racial origins, with some observations on mortality

Mean weights at various intervals over the first 2 years of life were calculated for Guyanese infants of East Indian and African ethnic groups who were born in 1964 and attended 14 clinics in rural areas. Compared with East Indians, African infants grew faster and weighed more at all ages, although their mortality experience was greater. It is suggested that Africans have a greater potential size than East Indians as a result of inherited factors. Compared with results from developed countries, weight increments in both ethnic groups were small from the 4th to 15th month, a time when mortality was relatively high. This growth pattern is found in many developing countries and reflects weaning difficulties. Profound changes in population, mortality rates and birth rates occurring in Guyana over the past century are summarized.