Modern Health Facilities Research Articles

Recent Rise in Poverty and Its Implications for Poor Households in Pakistan

There is sample evidence that poverty which declined rapidly in Pakistan in the 1970s and 1980s has increased in the 1990s.1 This rise in poverty is likely to have adversely affected the ability of poor households to enrol their young children in schools. The cost of schooling even when it is free is usually the most pressing obstacles for poor people to send their children in school. Similarly, health correlates strongly with poverty. This does not mean that poverty is itself a direct cause of diseases, but it lies behind other causes of disease such as in-sanitary living conditions, lack of adequate nutrition, poor access to safe drinking water, and sanitation and bad working conditions [World Bank (1993)]. Because of these factors, the poor are more affected by communicable diseases than are the rich. They have also less access to modern health facilities. This paper examines recent trends in poverty and their impact on primary school enrolment, health status and housing conditions in Pakistan.

The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi

To describe and compare the frequency of antenatally identified maternal 'risk' characteristics, place of delivery and occurrence of delivery complications. A prospective cohort study of 780 pregnant women completing antenatal follow-up at a rural health center in Malawi. Three-quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk characteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The 'at-risk' classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual 'risk' characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery. Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the 'risk' variables and the failure of the identified 'at-risk' individuals to deliver in modern health facilities.

Utilisation of malarial drugs at a household level: results from a KAP study in Choma, southern province and Mporokoso, northern province of Zambia.

To describe and document knowledge and use of anti-malarial drugs at household level in rural Zambia. Cross sectional study. Community based. Data was collected from 392 male and 415 female respondents. Percentage of respondents knowing the cause of malaria and using modern health facilities. The median age of respondents in Choma was 37(Q1 = 27, Q3 = 52) while that for Mporokoso respondents was 34(Q1 = 26, Q3 = 47), (p < 0.001). There was no association between educational level and knowledge of causes of malaria (p = 0.674). Fever was significantly (p < 0.001) associated with malaria (20.4% in Choma, 80.6% in Mporokoso). However, only 1% in both areas mentioned the mosquito as a vector for malaria. The majority of residents (59.5%) went to the hospital when they suffered from malaria. Only 7% mentioned the use of traditional medicine. There was an association between the level of education and taking preventive measures against malaria in all the communities (p < 0.001). Respondents did not mention the use of treated mosquito nets. Residents in both Choma and Mporokoso did not know the cause of malaria. The use of treated mosquito nets is rare. Production of information, education, communication (IEC) health materials and recruitment of a village health educator is recommended.

Mothers' perceptions and knowledge on childhood malaria in the holendemic Kibaha district, Tanzania: implications for malaria control and the IMCI strategy.

Prior to an intervention on improving the quality of malaria case management, we assessed mothers' abilities to recognize nonsevere and severe/complicated malaria in children when a child has fever with other physiological and behavioural symptoms associated with malaria. Malaria was mentioned as the commonest febrile illness (94. 1%), convulsions the least (11.4%). Fever and enteric symptoms featured as the most important symptoms of childhood malaria at frequencies of 93.5% and 73.8%, respectively. The need for laboratory diagnosis was very high (98.3%), the reason being to get accurate diagnosis and treatment (89.4%). Poor outcome of treatment was ascribed to incorrect diagnosis and prescription, noncompliance at home and ineffective drugs (62.1%). Most mothers (86.6%) would take antipyretic measures first when a child has fever, and subsequently the majority (92.9%) would seek care at a modern health facility. About 50% of the mothers would give traditional treatments for childhood convulsions and wait till fits cease before the next action. A high proportion of the mothers (75%) held the belief that an injection in a child with high fever would precipitate convulsions or death. The implications of these findings for chemotherapeutic malaria control in holoendemic areas within the context of the Integrated Management of Childhood Illnesses (IMCI) strategy are discussed.

Understanding Ethnic Variation in Pregnancy-related Care in Rural Guatemala

Objectives. This study examines the relatively low use of modern pregnancy-related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in care. Methods. The data for the analysis come from the Guatemalan Survey of Family Healtha population-based survey of rural women that contains detailed data on care received during pregnancy and delivery along with extensive background information. Binomial and multinomial logit models are used to identify the variables that affect the likelihood of receiving different types of care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the observed ethnic differences. Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend them by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly associated with modern pregnancy-related care than are measures of access and that the former variables explain more of the ethnic variation in care than the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction with traditional midwifery care rather than to rely solely on the former. Conclusion. The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to modern health facilities improves. Current efforts directed toward the training and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replacement of midwives with biomedical providers.

Ethnographic study of diarrhoeal diseases among under-five children in Mana District, Jimma Zone, Southwest Ethiopia

A cross-sectional design was employed to identify the local cosmology of childhood diarrhoea and its local treatment procedures. A total of 848 under-five children were identified by a quick inventory of randomly selected kebeles. Trained enumerators administered a pre-tested questionnaire in order to identify the socio-demographic and economic aspects of the community, knowledge of diarrhea, and its causes and treatments. Besides, a focus group discussion was employed among mothers whose children were found to have recent history of diarrhoeal attack. The survey data was analysed with SPSS/PC software while the qualitative data was manually analysed. The majority (66.4%) of mothers/care-takers reported to identify diarrhea by loose, white, watery stool with an episode of at least three times a day. Although 27.6% of the respondents claimed that they do not know causes, 23.4%, 21.6%, and 20.5% have pointed out evil eye, teething, and poor hygiene respectively, to be major causes of the problem. From the qualitative data, it was found that the type of diarrhea and the remedies to be taken varied remarkably. Accordingly, there could be frequent loose stool due to "hadji", evil eye, teething, and `bird'. The degree of concern and type of treatment does accordingly vary. Based on the two weeks recall period, the prevalence of diarrhea among the study community was found to be 33.7%. From the survey result, it was found that diarrhoeal disease is managed by resorting to modern health facilities, traditional healers, and both sectors, interchangeably, by 39.7%, 48.1%, and 10.4% of the respondents respectively. Although similar studies need to be conducted cross-culturally, one may safely conclude that plans for proper health care delivery should appreciate the underlying cultural ethos of the target population of concern. In the same vein, health education programs may also consider this as a point of departure. (Ethiopian Journal of Health Development: 2000, 14(1): 77-84)

Restorative gardens: the healing landscape

Restorative gardens for the sick, which were a vital part of the healing process from the Middle Ages to the early 20th century, provided ordered settings in which patients could begin to heal, both physically and mentally. In this book, a landscape architect, a physician and a historian examine the history and role of restorative gardens to show why it is important to again integrate nature into the institutional - and largely factorylike - settings of modern health care facilities. The authors present the history of restorative gardens and studies six American health care centers that cherish the role of their gardens in the therapeutic process. These institutions are examined in detail: community hospitals in Wasau, Wisconisn, and Monterey, California; a full-care mental institution in Philadelphia; a nursing home in Queens; a facility for rehabilitative medicine in New York City; and a hospice in Houston. In their comprehensive review the authors suggest that contemporary scientific understanding clearly recognizes the beneficial physiological effects of garden environments on patients' well-being. The book ends with a plea to make gardens - rather than the shopping mall atria so often seen in newly renovated hospitals - a vital part of the medical milieu.

Ngaka ya setswana, ngaka ya sekgoa or both? Health seeking behaviour in Batswana with pulmonary tuberculosis

The health seeking behaviour of tuberculosis (TB) patients, and their beliefs and attitudes with regard to the disease, was studied in 212 Batswana with smear-positive pulmonary TB during 1993/94. There is an apparent resemblance between traditional ideas of disease being caused by pollution (breaking of taboos) and modern theories of spread via germs. TB may be regarded as a `European disease' or as a `Tswana disease' and this has implications for health behaviour. Patients who regard TB as a `Tswana disease' may use modern medicine for symptom relief but traditional medicine to treat what they consider the cause of the disease. All patients were eventually diagnosed and initiated specific antituberculous treatment in a modern health facility. The median number of health facility visits was two, and the median delay period was 12 weeks. 95% of patients visited a modern health facility as their first step of action. Before start of specific treatment one or more alternative treatments was tried by 52% of patients during the delay period. After starting modern treatment, 47% of patients visited, or planned to visit, a traditional healer or a faith healer. Traditional explanations of disease seemed less prevalent in 1993/94 than in a study conducted among TB patients in Botswana ten years earlier, but few patients had a thorough understanding of TB from a biomedical point of view. More knowledge about patients' health seeking behaviour and perceptions would be useful for health workers. The findings of this study could offer suggestions for improvement in the area of health education.

Prevalence of skin disease in rural Tanzania and factors influencing the choice of health care, modern or traditional.

To determine the prevalence of skin disease in a rural Tanzanian community and to investigate the health-seeking behavior of this community. The study was in 3 parts: (1) 120 heads of households were interviewed to determine the factors that influence the families' health-seeking behavior; (2) the 800 members of these families were examined for evidence of skin disease; and (3) a focus group discussion was held with influential members of the community to get a broader view of health-seeking behavior. A rural village in the southwestern area of Tanzania: Individuals were interviewed and examined in their own homes. A total of 34.7% of 800 villagers had one or more skin diseases, the most common of which were tinea capitis, tinea corporis, scabies, acne, and eczema. Modern and traditional health facilities were equally used, but heads of the households older than 55 years who had never been to school and individuals who were not Christians favored traditional medicine. It was cheaper to go to a traditional healer, but modern medicine was thought to be more scientific. Skin disease was a problem in this village and was perceived to be a problem by both individuals and the community. There is a need to assess the clinical and diagnostic skills of both modern and traditional health practitioners and to instigate a preventive health education program to eradicate the common infections and infestations.

Traditional herbal medicines used to treat wounds and injuries in Nepal.

In rural Nepalese societies, due to the lack of modern health services and facilities, folk herbal preparations are still the dominant method of therapy for common ailments. These remedies are fairly well accepted, easily available, bear a minimal cost and are generally the only available resource. Information on the curative properties of 42 plant species from 40 genera and 23 families that are used to treat wounds and injuries, has been documented. These herbal remedies are based on ancestral knowledge and personal experience. Their successful use indicates that they are alive and functioning in the rural localities. Although the techniques of preparation of drugs or dosage forms employed by traditional healers have generally been observed to be poor and in most cases do not comply with the requirements of modern pharmaceutical practices, there are trends towards the development and modernization of practice including the standardization of specific dosage, storage of drugs, use of specific types of containers and their labelling. A critical evaluation of the phytochemistry and pharmacology of the alleged curative plants and the traditional pharmaceutical practices employed has been strongly recommended. In rural Nepalese societies, the number and distribution of traditional herbal practitioners and faith healers greatly exceed all other health workers. Their influence should be applied to the task of motivating the rural populace to adopt authentic herbal remedies and other health-related hygienic behaviour.

Utilization of health care in an African urban area: Results from a household survey in Ouagadougou, Burkina-Faso

This study analysed the level of utilization of different kinds of health care providers, and its correlates, by people reporting an illness via a household health survey in a representative sample of 547 households (3667 persons) in the city of Ouagadougou, Burkina-Faso in 1989. More than one-fourth of the sample reported suffering from a health care problem in the 2-week period preceding the interview. Self care was the most frequently reported type of care received (55.6%). Bivariate analysis and logistic regression revealed that the principal determinants of the utilization of modern care givers were age, socio-economic level, illness characteristics (type, length, severity), and cost of care and transportation. In particular, we found that: (1) Even though the family remained the main provider of care in case of minor (mild and short) illnesses, it did not prevent modern health facilities from playing their curative role in case of serious illnesses. (2) Residential zone (central versus peripheral zone) was not significantly associated with health care choice, which was contrary to expectation. (3) On the other hand, socio-economic status strongly affected health-seeking behavior. (4) The travel pattern of the ill persons favored health care facilities in the central zone. Taken together, the results of this study question the role of community health workers in the urban program of community health care which was in the process of being implemented at the time of the study. They suggest that the family, instead of the community health workers, should be seen as the provider of curative care for minor illnesses. Community health workers may have a more effective role in health education than in curative tasks.

Determinants of modern health care use by families after a childhood burn in Ghana.

This study examined determinants of modern health care use by families after their child aged 0-5 years sustained a burn injury in the Ashanti Region of Ghana. A community based survey of children aged 0-5 years was conducted in 50 enumeration areas in the region. Mothers of all children with scars as evidence of a burn were selected for a follow up interview using a standard questionnaire two to three months later. Determinants of health care use were investigated through a multivariate logistic regression using interview responses from mothers of 617 children for whom report on some treatment was given. Overall, 48% of the burned children were taken to a modern health facility for treatment. Of those taken to a modern health facility, 68% were sent within 24 hours of the burn event. Factors with large adjusted odds ratios for modern health care use included wound infection, burns covering 6% or more of the body surface, and third degree burns. Compared with scalds, children with contact and flame burns were less likely to be taken to a health facility, as were burns to rural children, and those given first aid treatment at home. It is concluded that families, particularly rural residents, should be educated about appropriate health care seeking practices after a burn.

Mother's Education and Utilisation of Health Care Services in Pakistan

Education is one of the crucial social development variables especially for mothers which enriches their mind about their social and reproductive experiences and broadens their understanding to make better choices for themselves and rearing and bearing of their children. In many developing countries there is evidence that mother's education plays an important role in determining child mortality even in situations where the medical facilities are scanty [Berrera (1990); Caldwell (1979, 1981)]. Education, it is argued influences women's beliefs about the good health, causes and cures of diseases that increases the demand of the utilisation of modern health care facilities. Therefore, educated mothers are more likely to seek medical treatment for themselves and for their children resulting in higher intensity of the use of a better quality modern care that grows with the advancement of education. Evidence from the research done elsewhere suggests that mother's education has individual positive effect on the use of health care facilities Abbas and Walker (1986); Berrera (1990) and Caldwell (1979) have pointed out that educated mothers are more likely to take advantage of the modern health facilities than their uneducated counterparts in compliance to the recommended treatments primarily due to the different attitudes in regard to the knowledge and perceptions of the importance of the modern medicine in the care of their children. Berrera (1990) in a study of child nutrition in the Philippines found that the children of educated mothers took more advantage of the public health care facilities than the children of uneducated mothers.

Infant mortality in Nigeria: effects of place of birth, mother's education and region of residence.

This paper examines the effects of a child's place of birth, mother's education, region of residence and rural and urban residence on infant mortality in Nigeria between 1965 and 1979, using data from the 1981/82 Nigeria Fertility Survey. Infant mortality rates declined in all regions between 1965 and 1979. Children born in modern health facilities, irrespective of their mothers' place of residence, experienced significantly lower rates of infant mortality than those born elsewhere. Logistic regression analysis showed that all other variables tested were also significant, although some to a lesser degree. Efforts to reduce infant mortality in Nigeria should include policies that rectify rural and urban differentials in the distribution of health facilities and encourage their use.

A short look at the history of the State Hospital of Sarajevo.

The State Hospital of Sarajevo has a tradition that is 127 years old. It is located on the spot where the first Turkish Army hospital—the first hospital on the territory of Bosnia and Herzegovina—was established in 1865. Through the ages, military health institutions in the city of Sarajevo always have been located on this spot. In its time, that first hospital was a modern health facility with its own running water and sewage system. It was used for the treatment of Turkish soldiers. Civilians had their facility built in 1866— the so-called Vakuf Hospital, the operation of which was aided occasionally by two military physicians.

Clinical Engineering Support for the Critical Care Unit

A tremendous selection of choices, both for goods and services, is available in the health care industry. Unfortunately, even marginal increases in expenses are hard to rationalize in today's market. To squeeze every bit from every dollar requires very active and dynamic leadership. Regulatory requirements, with the requisite documentation, must be met efficiently to free the organization to concentrate resources on providing primary health care. Capital dollars can be spent only on the best value to meet corporate objectives. The processes of health care delivery, risk assessment and management, and technology acquisition must be integrated on a corporation-wide scope to optimize the final product. To this end, the clinical engineering department brings essential skills to this participatory, dynamic management of modern health care facilities. This process of technology management has been implemented in various hospitals since 1985. Taking lessons from industry, hospital administrators are focusing management resources to address specific concerns. Clinical engineering, with its technical expertise, practical knowledge in the delivery of health care, and accrued database, is an essential part of this process. This technology management process involves an integration of experts to find specific solutions, and the supporting policies and procedures to ensure universal use of technology management.

Demographic variables in fetal and child mortality: Hmong in Thailand.

Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex-specific mortality rates calculated from reproductive histories show no surplus of female deaths in the past, but females have benefitted more from recent mortality declines than males. Ethnographic evidence suggests that Hmong have customs which act to protect the health of mother and child ('chicken soup theory'), and that they are predisposed to accept innovations (including use of modern medicine) which they see as beneficial. This may allow them to respond especially quickly to small opportunities for improving their children's survival, as compared with other ethnic groups.

Care for the elderly, care by the elderly: The role of elderly women in a changing Tswana society

With increasing urbanization and migration in Botswana and an increasing number of children born to unwed mothers, the grandmother (especially maternal) has become a key figure in many households. She is often the main care provider for children of absent daughters: a phenomenon observed elsewhere in Africa. But what happens when the grandmother herself is in need of care? There are indications that the elderly, especially old women, may have less access to modern health care facilities than the rest of the population. This article focuses on the family and resources available for care of the elderly, and presents preliminary results from an ongoing multidisciplinary project.

Folk Anthelmintic Drugs of Central Nepal

In rural societies of cenual Nepal, due to the lack of modern health services and facilities, herbal preparations are still the dominant methods of therapy for intestinal parasitic disorders. Information on the empirically accepted and frequently used anthelmintic properties of 39 plant species with additives has ken considered along with dosages and administration.

Preventing birth injury among women in Africa: Case studies in Northern Nigeria.

Among the most serious maternal injuries from childbirth in Africa is vesicovaginal fistula (VVF). Case studies of 55 VVF patients in northern Nigeria showed them to be poor, underage village women without sufficient access to modern health facilities at the time of the injury. Suggestions for short-term and long-term preventive measures are presented and discussed.