Community-level Health Service Research Articles

CAUSES OF VISITING ADOLESCENT GIRLS IN GYNAECOLOGY OPD AND THEIR AWARENESS OF REPRODUCTIVE HEALTH PROBLEMS

Background:-Adolescence is the transitional period between childhood and adulthood. As per the World health organization (WHO), adolescence includes the age group of 10-19 years. Adolescents constitute 20.0% of our total population and represent almost one-fth of the world's population The objective of these studies was to evaluate various causes of visiting adolescent girls in gynecology OPD and to assess their awareness about reproductive health problems. Material And Method:- This cross sectional study was conducted in a private clinic in district Shivpuri from 1 st April 2017 to 30 march 2022 In this study 668 adolescents were studied during this period. Detailed history, general examination, laboratory investigation, and pelvic USG were done to evaluate their health. Awareness of girls about reproductive and sexual health was interviewed. Results:- In this study, 668 adolescents were studied. The majority 54.04% of adolescent girls were between the ages of 14-16 years. Most 48.05% of them were educated up to 10th standard and most 74.10% of them were between BMI KG/m2 19-25 and the most 75.44% common age of menarche was between 11-13 years. Menstrual irregularities were the most common (58.68%) type of gynecological problem seen in adolescent girls. Frequency and percentage of other gynecological problems like breast problems, per vaginal discharge, Vulval itching, Hirsutism, Acne Lower abdominal pain, Dysurea & frequency of micturition, Bartholins cyst, contraceptive advise, Pregnancy/abortion, and post abortal bleeding in adolescent girls were 9%, 6.14%.,2.99%, 1.95%, 1.95%, 2.99%, 2.99%, 5.99% 2.10% and 1.05 respectively. Puberty menorrhagia (30.14%) was the most common type of menstrual disorder found among adolescent girls Frequency and percentage of other menstrual problems like Oligomenorrhea, and polymenorrhea. Primary amenorrhea, secondary amenorrhea, and Dysmenorrhea were 25.84% 12.92% 4.07% 18.18%, and 8.85% of adolescent girls respectively. AUB was the most common cause of puberty menorrhagia. polycystic ovaries were diagnosed in 37.30% of cases. Hypothyroidism was present in 3.97% and bleeding disorders were diagnosed in 1.59% of cases. Mullerian agenesis was the main cause (58.82%) of primary amenorrhea, and PCOD was the main cause of secondary amenorrhea 57.04% were aware of the physical science of pubertal development. Awareness about cancer cervix, HPV vaccination, and pap smear was found in only 17.96% of cases. 40.87% of cases were aware of cancer or breast and self-breast examination. STD awareness, HIV awareness, modes of transmission, awareness about contraceptives, awareness about the physiology of menstruation, awareness about anemia, awareness about menstrual hygiene, and awareness about tobacco and drug addiction were found in 50.90%, 25.00%, 53.89%, 20.96%, 61.98%, 25.00%, and 20.96% respectively. Conclusion:- In our study, menstrual disorders were the commonest gynecological problems among adolescents To create awareness and to promote knowledge regarding various health issues, health education classes and counseling of adolescent girls regarding reproductive health problems should be done Community-level health services should be well equipped with drugs, supplies of blood, and facilities for laboratory investigation to deal with reproductive health problems in adolescent

Development of China's health care system in the time of COVID‐19: Challenges, opportunities, and call for actions

Development of China's health care system in the time of COVID‐19: Challenges, opportunities, and call for actions

The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study

BackgroundPoor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers’ strikes in rural Kenya.MethodsThe study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods.ResultsThe monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3.ConclusionsThe findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Pilot action within the framework of the Mig-HealthCare project - implementation of community-based pilot studies addressing health inequalities of migrants and refugees

Abstract In the framework of the Mig-HealthCare project, a roadmap to community-based health care was developed including a toolbox and an algorithm. The Mig-HealthCare partners piloted parts of the roadmap in 8 EU countries. Piloting included actions on health promotion issues for migrants/refugees, mental health issues, non-communicable diseases, screening for breast and cervical cancer and vaccination issues. Two recommended practices were also piloted among migrants/refugees namely the 'circle of health' and health mentors while the Greek partner tested the developed algorithm in various health settings. All pilots were evaluated using common and pilot specific indicators for (a) appropriateness: the extent to which the piloted interventions were suitable for the target groups (service providers and/or migrants/refugees) (b) effectiveness: the extent to which the pilots' objectives were achieved, or are expected to be achieved, taking into account their relative importance (c) satisfaction: the extent to which pilots meet or surpass target groups and stakeholders (refugee/migrants, service providers and local population) expectation and needs (d) sustainability: the continuation of benefits from the pilot. Sustainability in the pilot implementation context is the ability of key target groups to sustain pilot benefits. Moreover, the impact of the interventions and their results should be sustainable in time. The impact of the pilots on the study population as well as implications for community-level health services are discussed.

Coping, Discrimination, and Physical Health Conditions Among Predominantly Poor, Urban African Americans: Implications for Community-Level Health Services.

African Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b=- 12.50, 95% CI=- 23.05, - 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.

Corrigendum to: Preventable hospitalisations in regional Queensland: potential for primary health?

Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention.Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012-June 2014) restricted to 51087 separations generated by 29485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups.Results Eleven per cent (n=5488) of all hospital separations were classified as PPH, and most were for common chronic (n=2486; 45.3%) and acute (n=2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people.Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families.What is known about the topic? PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations.What does this paper add? This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs.What are the implications for practitioners? Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians.

Information Improves Provider Behaviour: A Replication Study of a Community-Based Monitoring Programme in Uganda

In ‘Power to the People: Evidence from a Randomised Field Experiment on Community-Based Monitoring in Uganda’ (2009), Björkman and Svensson show that a relatively simple intervention – providing community-level health service delivery information and guidance on community-based monitoring – improved provider behaviour, health care utilisation, and health outcomes. In this paper we conduct a pure replication of the original study and extend the original analysis. Overall, we find that the intervention modified healthcare provider behaviours and utilisation, but that the results surrounding the programme’s impact on health outcomes appear less robust.

Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: A mixed methods study

BackgroundChina is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. This study aimed to understand the health seeking behaviour of and health systems responses to migrants and permanent urban residents suffering from chronic cough, in order to identify the factors influencing delays for both groups in receiving a TB diagnosis in urban China.MethodsCombining a prospective cohort study of adult suspect TB patients and a qualitative study, the Piot model was used to analyze the health seeking behaviour of TB suspects among migrants and permanent urban residents, the factors influencing their decision and the responses by general health providers. Methods included a patient survey, focus group discussions with migrants in the general population, qualitative interviews with migrant and permanent resident TB suspects and TB patients as well as key stakeholders related to TB control and the management of migrants.ResultsSixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01). When they first decided to seek professional care, migrants were 1.5 times more likely than residents to use less expensive, community-level health services. Only 5% were ultimately referred to a TB dispensary. Major reasons for both patient and provider delay included lack of knowledge and mistrust of the TB control programme, lack of knowledge about TB (patients), and profit-seeking behaviour (providers). In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).ConclusionRural-to-urban migrants are more likely than permanent residents to delay in seeking care for symptoms suggestive of TB in urban Chongqing. 'Patient-' and 'provider-' related factors interact to pose barriers to TB diagnosis for migrants, including: low awareness, and poor knowledge among both the general public and TB suspects about TB as a disease and about the TB control programme; low financial capacity to pay for care and diagnostic tests; and inadequate use of diagnostic tests and referral to TB dispensaries by general health providers.

Indicators of chronic health conditions: monitoring community-level delivery systems

As the creation and implementation of health policy become increasingly managed at the community level, ways must be found to ensure the proper measurement and monitoring of health program efficiency. 'Indicators of Chronic Health Conditions' explores the current understanding of selected chronic conditions and the capacity of community-level health services and delivery systems to address the health care needs for persons with the various illnesses. Beginning with a history of health indicators and community-level management of health services, this book goes further to examine the care needs and service delivery systems affecting different populations. These subpopulations include children, persons with mental retardation, persons with chronic mental illness, adults with physical disabilities, adults with chronic medical conditions, chronic substance abusers, and elderly persons. The volume concludes with ideas for monitoring community-level systems for persons with chronic health conditions. Professionals and students in the fields of health policy, public health, health care for persons with chronic illness, and public policy will benefit from the information provided.