Utilization Of Health Facilities Research Articles

Health Insurance for Universal Health Coverage in India

The role of health insurance in expanding Universal Health Coverage is to ease the access to healthcare services and reduce the risk of unexpected health expenditure burden. In order to examine this role, this article assesses the contribution of enrolment in health insurance on the utilisation of healthcare services and out-of-pocket expenditure for working-age Indians. Investigation into these two issues, addressing the self-selection/endogeneity problem in buying health insurance, is uncommon in the literature. Against this end, the probability of utilising healthcare services and the incurred out-of-pocket expenditure has been estimated using National Sample Survey (2017–2018) data in India. Empirical findings reveal evidence of endogeneity in health insurance enrolment for hospitalisation, which indicates the presence of self-selection in health insurance enrolment. Addressing the endogeneity problem, this study has found a higher probability of utilising hospitalisation and lower out-of-pocket expenditure among insured individuals than others. Socio-economic and demographic variables like household income, education, gender, religion and state of residence are important to determine the utilisation of healthcare facilities. On the other hand, while out-of-pocket expenditure incurred for hospitalisation significantly varies with age, gender, social caste, religion, working status, state of residence, nature of ailment and type of hospital, household income and health status have no significant effect on out-of-pocket expenditure. Poor people are less likely to be hospitalised, and compared to males, females have a higher probability of utilising healthcare services at their reproductive age. State-level health policies and health insurance schemes play a crucial role in determining health insurance participation and utilisation of health services. JEL: C13, C21, C25, I10, I11, I13, I14, I18

7604 Examining Disparities in Diabetes Control and Complications: A Comparative Study of Type 2 Diabetes Mellitus Patients in Rural and Urban Saudi Arabia

Abstract Disclosure: S.F. Alqifari: None. O. Alkomi: None. P. Amirthalingam: None. T. Alrasheed: None. M. Muqresh: None. H. Hamad: None. A. Khojah: None. N. Alshehri: None. B. Alhunayhani: None. B. AbuAlhasan: None. N. Alajlan: None. S. Alatawi: None. N. Alsabeelah: None. A. Wasel: None. A. Alqifari: None. Background: The escalating global prevalence of diabetes is also mirrored in Saudi Arabia. Approximately one in four individuals in the country is diagnosed with diabetes, as reported by the World Health Organization (WHO). The Ministry of Health has taken steps to address the needs of patients with diabetes by creating more than 20 specialized diabetes care centers in various regions throughout Saudi Arabia. However, disparities in access and utilization of primary healthcare facilities persist between rural and urban provinces within the country. Highlighting these disparities would bridge healthcare gaps between rural and urban areas to enhance diabetes management, ensure better access to specialized care, and improve the overall well-being of individuals living with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. Objectives: This study aims to examine disparities in diabetes control and complications in patients with T2DM in rural and urban Saudi Arabia. Methods: This is an observational retrospective study conducted from November 2022 until May 2023, we collected data from 13 diabetes care centers across Saudi Arabia to assess diabetes control and complications of T2DM among patients who received their care in rural and urban Saudi Arabia. Results: Among 709 patients residing in rural and urban areas, rural area patients' recent HbA1c readings were generally within the range of 7-8%. Among these patients, around 2.6% had a history of heart disease, and 6.08% had experienced cerebrovascular events. Limb numbness was reported by 44.34% of subjects, 47.82% experienced vision complications, and renal impairment was observed in 10.43% of the participants. Additionally, among male patients, 26.41% suffered from erectile dysfunction. Remarkably, 21% of the rural patients reported having been hospitalized due to diabetes complications at least once in the past 12 months. Conclusion: The study findings emphasize the importance of considering regional disparities and socio-environmental factors when managing diabetes and its complications. Additional research is needed to understand the underlying causes and develop targeted interventions for improved diabetes care in rural and urban populations in Saudi Arabia. Presentation: 6/2/2024

South Korean first-time mothers' knowledge of digestive health problems in infancy and their utilization of health care facilities for digestive health concerns: a descriptive study.

This study aimed to assess the knowledge level of first-time mothers regarding digestive health issues in infancy and to examine the utilization of healthcare facilities for such problems. Data from 119 first-time mothers of infants under 6 months of age were analyzed. Descriptive statistics, t-test, and one-way analysis of variance (ANOVA) were conducted using the SPSS software. The average correct response rate for first-time mothers' knowledge of digestive health problems in infancy was 61.9%. The highest correct response rate was observed for infantile colic, while diarrhea had the lowest. Less than 50% of mothers received education on infant digestive health problems across all categories. Among digestive health problems in infancy, diarrhea exhibited the highest rate of healthcare utilization, whereas infantile colic had the lowest. First-time mothers' knowledge of digestive health problems in infancy varied based on maternal age (t=-3.66, p<.001), education level (t=-2.26, p=.026), and planned pregnancy (t=3.24, p=.002). Moreover, mothers who received education on infant digestive health problems demonstrated better overall knowledge of digestive health problems. The rate of education regarding digestive health problems during infancy among first-time mothers was < 50%. Furthermore, mothers educated on infant digestive health issues exhibited improved knowledge. Therefore, it is necessary to provide appropriate pre-education to primiparous common gastrointestinal health issues in infants.

Estimates and determinants of health facility delivery in the Birhan cohort in Ethiopia.

Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aimed to measure the prevalence and determinants of health facility delivery in the Amhara region in Ethiopia. From December 2018 to November 2020, we conducted a longitudinal study from a cohort of 2801 pregnant women and described the location of delivery and the association with determinants. We interviewed a subset of women who delivered in the community and analyzed responses using the three delays model to understand reasons for not using health facility services. A multivariable poisson regression model with robust error variance was used to estimate the presence and magnitude of association between location of delivery and the determinants. Of the 2,482 pregnant women followed through to birth, 73.6% (n = 1,826) gave birth in health facilities, 24.3% (n = 604) gave birth at home and 2.1% (n = 52) delivered on the way to a health facility. Determinants associated with increased likelihood of delivery at a health facility included formal maternal education, shorter travel times to health facilities, primiparity, higher wealth index and having attended at least one ANC visit. Most common reasons mothers gave for not delivering in a health facility were delays in individual/family decision to seek care. The proportion of deliveries occurring in health facilities is increasing but falls below targets. Interventions that focus on the identified social-demographic determinants and delays are warranted.

Spatial Assessment of the Effect of Income on Healthcare Facilities Patronage in Kogi-East Senatorial District, Kogi State, Nigeria

This study assessed the level of income on health facility patronage in Kogi East, Kogi State, Nigeria. Primary data necessary for this study were collected from patients, health workers and residents of Kogi East through the administration of questionnaires, personal observations and obtaining of satellite imageries for creation of digital health facilities distribution map of the study area, while the secondary sources includes published documents. A total of 400 questionnaires were administered; however, only 395 were returned for analysis. Results were presented in both tables and charts while the hypothesis was tested using Correlation Analysis. Findings from this research revealed that majority of the respondents (58.80%) do not patronize any health facilities due to the high cost of treatment. The study also found that the major illness that affects respondents in Anyigba is Malaria Fever (76.5%); the result also shows 87.5% of the respondents disclosing that money has prevented them from patronizing health facilities. The study further found that the socio-economic characteristics of the residents/patients play a significant role in determining the frequency of visits to healthcare facilities; this is substantiated with the Pearson correlation test result that revealed a significant relationship between patronage pattern and monthly income of the respondents. This research also revealed that the lower the incomes of an individual, the limited access such individual would have to health facilities and vice versa. Given the z-score of 0.288134438445, the distribution pattern of the health facilities does not appear to be significantly different than random, as the healthcare facilities map also support the above claim. It is therefore recommended that efforts should be put in place to improve the socio-economic status of individuals so as to improve their access and utilization of healthcare facilities. Government at all levels as well as the organized private sector should carry out massive public awareness on the importance of health insurance scheme.

Factors Associated with Enrollment of Household in National Health Insurance Program in Eastern Nepal

Background Health insurance is entrusted to make health services more equitable and decrease the financial burden caused by catastrophic out-of-pocket payments. This study aimed to assess the factors affecting the enrollment of households in National Health Insurance Program (NHIP) in eastern Nepal.MethodsCross-sectional data were collected from 189 households in Itahari sub-metropolitan city using a structured questionnaire. Chi-square tests was used to examine the association between NHIP enrollment and selected demographic variables derived from the data.ResultsThe findings showed that 63% of households were enrolled in NHIP and enrollment was associated with education, family type, ethnicity, socio-economic status, prior experience of illness, utilization of health facilities, and knowledge regarding NHIP.Conclusions Variables like education, family type, ethnicity, socio-economic status, prior experience of illness, utilization of health facility, knowledge regarding the annual premium amount, annual benefit ceiling, and renewal time found to be associated with NHIP enrollment.

The effect of text-messaging on the utilisation of health facilities among pregnant women during delivery in Cross River State, Nigeria

Objective: Uptake of skilled care during delivery is associated with positive maternal and neonatal health outcomes. Studies reveal Nigeria accounts for a significant percentage of global maternal deaths, which have been associated with poor skilled attendants at delivery. Text messaging has proven to be effective in promoting health facilities’ utilisation in Nigeria. Therefore, this research assessed the influence of text messaging intervention on the utilisation of health facilities during delivery in Cross River State Methods: Quasi-experimental research design was employed. A sample size of thirty per LGA in two LGAs was used. Participants were purposively selected and grouped into text messaging and Control Groups ). The experimental group received text briefs three times per week for four weeks, while the control group received regular ANC sessions. A structured and validated questionnaire with Cronbach’s alpha coefficients ranging from 0.76 to 0.81 was used for data collection. Data were analyzed using descriptive and inferential statistics at a 5% level of significance. Results: At baseline, the proportion of women who utilised HFs during delivery was 13.3% (experimental group) and 33.3% (control group). Furthermore, at the 8th-week follow-up, there was a significant difference (p &lt; 0.05) in T-M (76.7%), compared with CG (33.3%) with an increase of 63.4% for the T-M compared to CG (3.3%, p &gt; 0.05). Conclusion: T-M intervention improved the utilisation of HFs during delivery among PW. The study recommends that health workers should incorporate mobile T-M intervention strategy which has proven to be a useful tool during ANC.

Utilization of maternal health facilities and rural women’s well-being: towards the attainment of sustainable development goals

BackgroundThe sustenance of any household is tied to the well-being of the mother's health before, during, and after pregnancy. Maternal health care has continued a downward slope, increasing maternal mortality in rural communities in Nigeria. Presently, few empirical findings connect maternal healthcare facilities' use to mothers' well-being in Nigeria. Using maternal health facilities and the well-being of rural women is crucial in achieving the United Nations’ Sustainable Development Goals 1, 2, and 3 (No poverty, zero hunger, good health, and well-being).ObjectiveThe objective of the study was to examine the level of maternal healthcare utilization and its effect on mothers’ well-being status among mothers in rural Nigeria.MethodsIn this study, secondary data extracted from the Nigeria’s 2018 National Demographic Health Survey was used. Data was analyzed with Multiple correspondence analysis, Fuzzy set analysis, and Extended ordered logit model.ResultsWomen in rural Nigeria were moderate users of maternal health care services and had moderate well-being indices (0.54 ± 0.2, 0.424 ± 0.2, respectively). Mothers' moderate well-being status was increased by using maternal health care facilities, having a larger household, and having mothers who worked exclusively in agriculture.ConclusionWe concluded that mothers in rural Nigeria use maternal healthcare facilities moderately, and their well-being level was improved using maternal healthcare facilities. Therefore, Nigeria’s Ministry of Health should raise awareness about the vitality of mothers using health care services before, during, and after pregnancy. In order to promote greater female participation in full-scale agricultural production, it is imperative for the Nigerian government to allocate substantial resources in the form of subsidies and incentives. The Nigerian government should source these resources from various channels, including expanded development cooperation. Additionally, policymakers should focus on designing developmental programmes specifically tailored for rural households and the health sector.

Increasing the Utilization of Health Facilities through Education: Case Study in Gentungang Village, West Bajeng District, Gowa Regency

A vital component that supports human life's well-being is health. World Health Organization (WHO) and Indonesia's Law No. 36 of 2009 both define health as the state of being physically, mentally, spiritually, and socially. Another acknowledged basic human right is health. This study emphasizes the value of public health programs that target the general public and work to prevent and improve health. Nonetheless, the community has not made the best use of the healthcare facilities that are available. The purpose of this study is to raise public awareness of health care facilities and encourage greater usage of them. The approach is outreach through talks, panel discussions, and Q&amp;A sessions. The results show that public awareness of health facilities is quite high, yet incomplete information leads to difficulties in using available facilities. In order to increase public awareness and trust in government health services, comprehensive education and clear information are essential.

The Influence of Health Education on Developmental Tasks in Caring for Elderly Family Members with Hypertension

This writing aims to understand the health education of elderly families in responding to the presence of family members by using a Quasi Experiment research type approach to assess the influence of health education on family health tasks in caring for elderly family members with hypertension. The research design was a pre-post experiment by measuring before and after the intervention was carried out (Notoatmodjo, 2010). Conclusion of the influence of health education on family health tasks in caring for (knowing, deciding, providing care, modifying the environment, utilizing health facilities) in elderly people with hypertension with a value (P &lt; 0.05), namely 0.002 &lt; 0.05, there is a significant difference between Family Health Tasks in Caring for Elderly Family Members with Hypertension before and after Implementing Health Education with a P Value &lt;0.05. namely 0.000 &lt; 0.05. It is hoped that health workers or community health centers will continue to increase socialization and motivation for elderly families to be more active in helping elderly people to improve their health status.

Learnings From the Implementation of an Electronic Human Resource Management System for the Health Workforce in Uttar Pradesh, India.

The state of Uttar Pradesh (UP), India, has one of the largest single public health systems globally, serving about 235 million people through more than 30,000 public health facilities with approximately 160,000 health personnel. Yet, the UP health system has a shortfall of public health facilities to meet the population's needs, a shortage of clinical and nonclinical health personnel, inequitable distribution of existing health personnel, and low utilization of public health facilities. A robust and effective electronic human resource management system (eHRMS) that provides real-time information about the lifecycle of all health professionals in UP may aid in improving the health workforce, resulting in better health services and improved health outcomes. The Government of UP rolled out Manav Sampada, a comprehensive eHRMS that complied with global norms and requirements. We describe the implementation of Manav Sampada at scale and elaborate on key learnings and adoption strategies. Manav Sampada was based on key principles of integration and data-sharing with other digital systems, included functional components, a minimum dataset, used a lifecycle-based approach, and a workflow-based system, all of which acted to improve human resource data quality. The eHRMS emerged as a valuable tool for key stakeholders in reviewing worker performance, identifying skill-building needs, and allocating resources for training, leading to improved availability and equity in the distribution of a few critical cadres. The eHRMS in UP is well positioned to become an integral part of the Ayushman Bharat Digital Mission, the backbone of India's integrated digital health infrastructure. Linking eHRMS to a planned beneficiary-centric unitized health service delivery system (capturing information at the individual level rather than the aggregate level) will enable the measurement of service delivery and quality, leading to improved workforce management.

Loneliness impact on healthcare utilization in primary care: A retrospective study

BackgroundAn increased number of patients seek help for loneliness in primary care. ObjectiveTo analyze whether loneliness was associated with a higher utilization of healthcare facilities. MethodsObservational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. ResultsA total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6–9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. ConclusionLoneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

Care seeking behavior of the victims of unintentional injuries: A community-based study in a community development block of Purba Bardhaman District, West Bengal.

Care-seeking after injury episodes is generally associated with major uncertainties concerning its incidence, care, and cure/disappearance, and the price of care. Though the utilization pattern of the population is shaped by social, economic, cultural and political factors, it varies widely for the rich and the poor. With this background, a community-based epidemiological study was conducted to determine the care-seeking behavior of victims of unintentional injuries. A cross-sectional study was conducted from May 2023-September 2023 in the Bhatar block of Purba Bardhaman district, West Bengal. Cluster random sampling was applied to select a required sample of 555 individuals from 24 villages. Study tools used were predesigned and pretested schedules developed by the researchers with the help of guidelines for conducting community surveys on injuries provided by the World Health Organization (WHO). The study had approval from the Institutional Ethics Committee. Descriptive statistics were performed using SPSS V16. Out of 49 injury episodes, 51.0% had received first aid. Out of 39 injury episodes seeking medical attention, a traditional practitioner, healer or bone setter was the type of first medical contact in the case of the majority of injury episodes (38.5%), followed by a hospital (35.9%). Low utilization of government healthcare facilities is a cause for concern. Reliance on unqualified informal healthcare providers is also a cause for concern. Our findings will help design community interventions to increase the provision of appropriate first aid in unintentional injuries.

IJCM_15A: Health-seeking behaviour among Fishermen community mothers of under-five children on childcare– A cross-sectional study

Background: Globally in 2020 an estimated 5 million children under5 years died mostly from preventable and treatable causes. India ranks second worldwide in under5 mortality (WHO2020). Health of the children is strongly dependent on parental healthcare behaviour Fishermen-community possesses unique characteristics of a folk-society, Major portion of the life of fishermen is spent at sea, mothers assume a vital place with regard to the upbringing of the children. Objective: To study the health-seeking behaviour among Fishermen- community mothers of under-five children during acute illness and factors associated with it Methodology: A cross sectional study was conducted among 100 Mothers of Under five children in a Fishermen community, Kovalam, Chengalpattu district of Tamil Nadu over a period of 3months (October 2023–November 2023). Data collection was done using interviewer administered semi-structured questionnaire, statistical analysis was done using SPSS v21.0 Results: In total, 100 mothers with mean age of 27± 3.3 years participated in the study, all of them reported of some health morbidity. The proportion of health seeking behaviour in terms of appropriate and prompt care among the study population was 42%. The reason for delayed health care seeking among the participants were due to over-the-counter drugs(33%), self-medication(17%) and home remedies(8%). Among them 84% sought health care from private health facility. Appropriate and prompt care has found to be significantly associated with the age of the child less than 2 years (OR-3.485,95%CI-1.449-8.382), educational status of the mother (above high-school) (OR-3,95%CI-1.328-6.977), extended family type (OR- 2.679,95%CI-1.151-6.233) and perception about severity of illness during an episode of acute illness. Conclusion: Appropriate Health-seeking behaviour and seeking prompt care among parents of children was inadequate. Utilization of public health facility was less. Hence, steps can be taken to sensitize the mothers about the services available in the public health care facility.

Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data.

Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India. We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch's t-test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike's Information Criterion (AIC) and adjusted R2 values to identify the best-fit model. We find no significant difference between urban and rural areas (P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India. Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

Chronic diseases and determinants of community health services utilization among adult residents in southern China: a community-based cross-sectional study

BackgroundThe burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents.MethodsData were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization.ResultsAccording to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently.ConclusionsGiven the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents’ access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.

Comparison of Janani Suraksha Yojana (JSY) and augmented Arogya Laxmi scheme (ALS) in improving maternal and child health outcomes in urban settlements of Hyderabad, South India

BackgroundIndia accounts for the largest number of global neonatal deaths with around 20 per 1000 live births. To improve the utilization of government services for institutional deliveries, Augmented Arogya Laxmi Scheme (ALS) was launched in Telangana state of southern India. This study assessed the effectiveness of the Janani Suraksha Yojana (JSY), which combines cash assistance with delivery and post-delivery care, in comparison to ALS in improving the outcomes related to antenatal, natal, and postnatal care in urban settlements of Hyderabad, Telangana, southern India.MethodsThis was a two-year cross-sectional study conducted in 14 urban settlements of Hyderabad city from September 2017- August 2019. All mothers delivered during the 18 months preceding the survey were enrolled after a written informed consent. Field investigators collected data on variables related to socio-demographic characteristics, awareness, and utilization of JSY and ALS programs. Variables related to antenatal history, antenatal care, complications during birth, delivery outcomes, newborn care, and postnatal care till 28 days were assessed. We used multivariable logistic regression model to examine the association between the different maternal, child, and socio-demographic characteristics of the two study groups.ResultsA total of 926 mothers were beneficiaries of Janani Suraksha Yojana (JSY) program while 933 mothers were beneficiaries of augmented Arogya Laxmi Scheme (ALS). Mothers in ALS group (AOR 1.71; 95% CI 1.21–2.43) were at increased odds of having more than eight antenatal care (ANC) visits compared to the mothers availing JSY. Mothers in ALS group were at decreased odds of having complications like severe pain in the abdomen (AOR 0.43; 95% CI 0.22–0.86), swelling of legs or feet (AOR 0.59; 95% CI 0.44–0.80) compared to mothers in JSY group. Children of mothers in the ALS group had increased odds of receiving breastfeeding within 30 minutes of birth (AOR 1.46; 95% CI 1.13–1.88) compared to children of mothers in JSY group.ConclusionsThe newly launched augmented ALS led to the increased utilization of the government health facilities and improved the maternal and child health outcomes.

Utilisation of public healthcare services by an indigenous group: a mixed-method study among Santals of West Bengal, India.

A barrier to meeting the goal of universal health coverage in India is the inequality in utilisation of health services between indigenous and non-indigenous people. This study aimed to explore the determinants of utilisation, or non-utilisation, of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study holistically explored the utilisation of public healthcare facilities using a framework that conceptualised service coverage to be dependent on a set of determinants - viz. the nature and severity of the ailment, availability, accessibility (geographical and financial), and acceptability of the healthcare options and decision-making around these further depends on background characteristics of the individual or their family/household. This cross-sectional study adopts ethnographic approach for detailed insight into the issue and interviewed 422 adult members of Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal for demographic, socio-economic characteristics and healthcare utilisation behaviour using pre-tested data collection schedule. The findings revealed that utilisation of the public healthcare facilities was low, especially in urban areas. Residence in urban areas, being female, having higher education, engaging in salaried occupation and having availability of private allopathic and homoeopathic doctors in the locality had higher odds of not utilising public healthcare services. Issues like misbehaviour from the health personnel, unavailability of medicine, poor quality of care, and high patient load were reported as the major reasons for non-utilisation of public health services. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalised populations because these communities live in geographically isolated places and have low affordability of private healthcare. The health programme needs to address these issues to improve the utilisation and reduce the inequality in healthcare utilisation, which would be beneficial for all segments of Indian population.

Impact of Referral Guideline Enforcement on Orthopedic and Trauma Admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A Pre-Post Test Design

Background: The suboptimal utilization of tertiary health facilities and inadequate management of referral systems in low- and middle-income countries pose challenges to health system administration, characterized by frequent self-referrals and bypassing of lower-tier health facilities. On July 1, 2021, Kenyatta National Hospital (KNH) implemented referral guidelines, mandating that all admitted patients be referred from lower-tier health facilities, aligning with the KNH legal statute of 1987. This study aimed to evaluate the impact of enforcing referral guidelines on the spatial distribution of orthopedic and trauma admissions at KNH.&#x0D; Methodology: A pre-posttest study design was employed, reviewing a total of 459 and 446 charts in 2021 before and after the enforcement of referral guidelines. Measures of central tendencies and Chi-squared tests were applied, and density plots were generated using Geographic Information System (QGIS 2.18.19) to illustrate the spatial distribution of admissions.&#x0D; Results: of KNH admissions, 85.3% and 79.3% originated from Nairobi County and its environs. Admissions were geographically diverse, with a notable concentration from Nairobi County and its environs. Enforcement of referral guidelines led to a significant decrease in admissions from Nairobi County, dropping from 64.3% to 56.9% (p=0.019). Declines were particularly observed in Kamukunji, Embakasi, and Ruaraka sub-counties, serving as the catchment population for Mama Lucy Kibaki Referral Hospital. Conversely, admissions from Kibra and most of Kajiado County were notable. There was a concurrent increase in admissions from other parts of the country (p = 0.003).&#x0D; Conclusion: Over four-fifths of KNH admissions are from Nairobi County and its environs. The enforcement of referral guidelines resulted in decreased local admissions and an uptick in admissions from other regions in the country.