Private Doctors Research Articles

Cultural differences in postnatal quality of life among German-speaking women - a prospective survey in two countries.

BackgroundAssessment of quality of life after childbirth is an important health-outcome measurement for new mothers and is of special interest in midwifery. The Mother-Generated Index (MGI) is a validated instrument to assess postnatal quality of life. The tool has not been applied for making a cross-cultural comparison before. This study investigated (a) responses to the MGI in German-speaking women in Germany and Switzerland; and (b) associations between MGI scores on the one hand and maternity and midwifery care on the other.MethodsA two-stage survey was conducted in two rural hospitals 10 km apart, on opposite sides of the German-Swiss border. The questionnaires included the MGI and questions on socio-demographics, physical and mental health and maternity care, and were distributed during the first days after birth and six weeks postpartum. Parametric and non-parametric tests were computed with the statistical programme SPSS.ResultsA total of 129 questionnaires were returned an average of three days after birth and 83 in the follow-up after seven weeks. There were no statistically significant differences in the MGI scores between the German and the Swiss women (p = 0.22). Significantly more favourable MGI scores were found associated with more adequate information during pregnancy (p = 0.02), a more satisfactory birth experience (p < 0.01), epidural anaesthesia (p < 0.01), more information (p = 0.01) and better support (p = 0.02) during the time in hospital and less disturbed sleep (p < 0.01). Significantly lower MGI scores were associated with the presence of a private doctor during birth (p = 0.01) and with exclusive breastfeeding during the first postnatal days (p = 0.04).ConclusionThe MGI scores of these German-speaking women were higher than those in other studies reported previously. Thus the tool may be able to detect differences in postnatal quality of life among women with substantially divergent cultural backgrounds. Shortcomings in maternity and midwifery care were detected, as for example the inadequate provision of information during pregnancy, a lack of individualised postpartum care during the hospital stay and insufficient support for exclusively breastfeeding mothers. The MGI is an appropriate instrument for maternity care outcome measurement in cross-cultural comparison research.

Making the Most of the Affordable Care Act's Contraceptive Coverage Mandate for Privately-Insured Women

Under the Patient Protection and Affordable Care Act of 2010 (ACA), most women of reproductive age with private health insurance have, or will soon have, first-dollar coverage of contraception and contraceptive counseling. The need for contraceptive coverage is great, because most American families want two children, resulting in the average woman spending three decades of her reproductive life trying to avoid pregnancy (Guttmacher Institute, 2012; Finer & Philbin, 2014). Contraceptive coverage without cost sharing is a sea change in women’s health insurance. This policy change has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy ratedwhich stands at approximately half of all pregnancies (Finer & Zolna, 2014)dand to improve the health of women and families. In this commentary, we argue that realizing the potential of this policy change requires more action on the part of public health practitioners, insurers, health care providers, and researchers than is currently evident, andwe offer some suggestions for making the most of first-dollar contraceptive coverage.

Informal rural healthcare providers in North and South India.

Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south). We mapped and interviewed IPs in all nine blocks of Tehri and in nine out of 57 blocks in Guntur, and then interviewed a smaller sample in depth (90 IPs in Tehri, 100 in Guntur) about market practices, relationships with the formal sector, and their knowledge of protocol-based management of fever, diarrhoea and respiratory conditions. We evaluated IPs’ performance by observing their interactions with three patients per condition; nine patients per provider. IPs in the two districts had very different educational backgrounds—more years of schooling followed by various informal diplomas in Tehri and more apprenticeships in Guntur, yet their knowledge of management of the three conditions was similar and reasonably high (71% Tehri and 73% Guntur). IPs in Tehri were mostly clinic-based and dispensed a blend of allopathic and indigenous drugs. IPs in Guntur mostly provided door-to-door services and prescribed and dispensed mainly allopathic drugs. In Guntur, formal private doctors were important referral providers (with commissions) and source of new knowledge for IPs. At both sites, IPs prescribed inappropriate drugs, but the use of injections and antibiotics was higher in Guntur. Guntur IPs were well organized in state and block level associations that had successfully lobbied for a state government registration and training for themselves. We find that IPs are firmly established in rural India but their role has grown and evolved differently in different market settings. Interventions need to be tailored differently keeping in view these unique features.

Effects of the expansion of doctors’ offices adjacent to private pharmacies in Mexico: secondary data analysis of a national survey

ObjectivesTo compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors’ offices adjacent to private pharmacies (DAPPs) users with users of Social Security...

Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan.

BackgroundSince 1990, Pakistan has faced an unprecedented rate of urbanization, thereby resulting in the uncontrolled proliferation of slums (Katchi Abadis) in all large cities. These areas lack the basic municipal services such as safe water supply, sanitation and waste collection. There is limited access to quality health care services, both curative and preventive. Therefore, communities living in katchi abadis are faced with health seeking challenges and catastrophic expenditure to pay for health care services (formal or informal).MethodsThis cross-sectional quantitative study was conducted in Islamabad, using a semi-structured questionnaire with mothers of children 5 years of age. There are 34 katchi abadis, 11 are recognized by the Capital Development Authority, out of which seven were included in the study. The calculated sample size was 207.Main findingsAverage household income was found to be Pak Rupee 10,000 (approx.US$100) per month. Diarrhea, fever, common cold and cough were common illnesses among under 5 children. Approximately 43% of the mothers were illiterate and they preferred consulting a private doctor or a private dispenser in the katchi abadi. Mother’s level of education was significantly associated with the type of health provider consulted. Majority had to spend out of pocket, while many either borrowed money from relatives or friends or sold a household item. Delay in seeking health care added to the out of pocket expense. The mean cost on child’s treatment was approximately PkRs400 (approximately US$ 4) for a single consultation.ConclusionThere are several factors associated with health seeking behavior of mothers of children under the age of 5 years, living in the katchi abadis of Islamabad. The latter population group is one of the most vulnerable given their poor standard of living conditions. A multi-sectoral approach is needed to address the provision of basic amenities, the availability of safety nets to pay for health care is crucial to avoid catastrophic expenditure and the provision of community-based health promotion programs are essential to improve health seeking behaviors whilst simultaneously promoting and protecting health.

A Cross-Sectional Study to Evaluate the Awareness and Attitudes of Physicians Towards Reducing the Cost of Prescription Drugs, Mumbai

In India, about half of the total health expenditure is spent on medicines. The projected increase in various diseases coupled with the skyrocketing drug prices have further compounded the drug cost burden. We conducted a study to assess the awareness, attitudes, and practices of physicians with regard to various cost containment measures and the factors affecting them. A cross-sectional, questionnaire-based, observational study was conducted over a period of 3 months among 200 physicians, after permission from the Institutional Ethics Committee, at the Grant Medical College and Sir J J Group of Hospitals, Mumbai. The STROBE (Strengthening The Reporting of OBservational studies in Epidemiology) guidelines were followed. Cost considerations were important to 97% of government doctors (GDs) and 72% of private doctors (PDs). Eighty percent of both GDs and PDs said that safety and efficacy were more important than cost. Seventy-one percent of GDs and 65% of PDs knew about the various cost reduction methods. Twenty-four percent of GDs and 65% of PDs said that they graded drugs according to cost. Ninety-four percent of GDs and 73% of PDs said that patent protection should not be extended to life-saving drugs. Sixty-four percent of GDs and 10% of PDs, and 20% of GDs and 10% of PDs were in favor of the stepwise introduction of drugs and the use of generics, respectively. Factors precluding the use of cheaper alternatives were narrow therapeutic index drugs (43.5%) and fear of substandard quality (38.5%). Doctors are indeed concerned about the high cost of drugs. More awareness needs to be created about the use of cheaper generics. The government has a very important role to play in reducing the cost of prescription drugs and making healthcare affordable.

Correlates of maternal health care utilization in rohilkhand region, India.

Background:Until date, the importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, natal and postnatal care. However, uptake of maternal health care services is far from universal even in settings where they are extensively available.Aim:The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in rural areas of Bareilly.Subjects and Methods:This was a cross-sectional study was conducted during June-December 2011. Six villages were selected by convenience out of 99 villages in Bhojipura Block of Bareilly district, Uttar Pradesh to cover maximum number of women. All currently married women aged between 15 and 49 years who had delivered a child within last 1 year were interviewed by house-to-house survey and comprised the study unit. Their socioeconomic and demographic characteristics, reproductive history and knowledge of specific obstetric complications were taken. The information was gathered on various aspects of maternal-care utilization. In analyzing data, both bivariate and multivariate analyses were employed, using the Microsoft Excel and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois,USA).Results:Most (88.6%; 343/387) of pregnancies had registration for antenatal care (ANC). Majority (69.7%; 239/343) of them were registered between 16 and 24 weeks. Only 28.5% (110/343) of women received ANC from a private doctor. Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio-economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having birth interval <24 months, among Muslims, working mothers and among those belonging to joint family. Mother's education and husband's occupation were found to be strong predictors for the utilization of maternal health care using the logistic regression.Conclusion:Utilization of maternal health care services is high. However this can be improved by community based education program.

Knowledge, attitude and practice of pharmacovigilance among private healthcare professionals of Rajkot city

Background: Spontaneous reporting is an important tool in pharmacovigilance. However, its success depends on cooperative and motivated prescribers. In order to improve the reporting rate, it is essential to improve the Knowledge, Attitude and the Practices (KAP) of the healthcare professionals with regards to the ADR reporting and the pharmacovigilance. The present study was undertaken to evaluate the knowledge, attitude, and practices (KAP) of pharmacovigilance among private prescribers of Rajkot city. Methods: It was a prospective questionnaire based survey type of study which was carried out among the private practitioners of Rajkot city. A questionnaire which was suitable for assessing the basic Knowledge, Attitude and the Practice (KAP) of pharmacovigilance was designed and distributed among the private doctors and filled up forms collected back and analyzed by microsoft excel 2007. Results: Out of 600 distributed forms 332 forms were received back, reflecting a response rate of 55.33%. 13.86% doctors didn’t know about the term pharmacovigilance. 76.80% doctors experienced ADR during their clinical practices. 17.77% doctors maintain the record for patient safety and medico legal aspect.13.25% doctors reported ADR at different places. Lack of knowledge and awareness and medico legal problems were common reasons for under reporting of ADR.78.30% doctors agreed to keep ADR monitoring mandatory. Preferred methods for reporting ADR were electronic media and personal communication. Conclusions: There was a great need to create awareness among the private doctors to improve the reporting of ADRs. Even though ADR reporting make compulsory by doctors unless there is no strict government rules and regulation success of pharmacovigilance programme is questionable.

EPA-0607 – Patterns of service use in the elderly: preliminary results of the 10/66-dementia research group prevalence study in portugal.

Above 60 years, prevalence rates of neuropsychiatric disorders double with every 5.1 years of age (from 0.7% at 60-65 years to 23.6% for those aged 85 or older). As aged people are dramatically increasing in Portugal, a Country under a serious financial crisis, it is important to understand whether health services are being used appropriately. to characterize the use of health services among the elderly, as part of the implementation of the 10/66-Dementia Research Group Population-based Research Protocol in Portugal. A cross-sectional survey was implemented of all residents aged 65 or more in a semi-rural area in Southern Portugal. Core evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). A structured questionnaire assessed the use of services, including health care providers (public, private), inpatient episodes, medication and costs. 703 participants were evaluated. Almost half of the participants (48,9%) were in contact with public primary care facilities, but only 22,5% had a contact with a hospital service. In both settings, nurses and other non-doctor professionals were rarely involved (6,4%) as principal care providers. 11,8% had at least one contact with a private doctor. Inpatient episodes in the last 3 months were very infrequent (3%). The National Health Service covered most costs. Previous research strongly suggests that health services are not provided equitably to people with mental disorders, namely the elderly. Reliable and cross-culturally comparable information about patterns of care may guide the implementation of adequate management in this area in Portugal.

Accreditation of Private Labs for Quality Participation by Private Practitioners in RNTCP: A Cross Sectional Study

Setting : Privately practicing doctors trained in modern system of medicine in East Delhi area Objective : To determine the reliance on sputum microscopy as ordered by private medical practitioners for diagnosis of pulmonary Koch's as well as monitoring their progress Method : Quantitative data was obtained using a semi- structured interview schedule administered to 102 private practitioners trained in modern system of medicine who were registered with the East Delhi Branch of Indian Medical Association as listed in its Directory 5th Edition. Corresponding qualitative data was obtained from key informants through interviews of government functionaries that focused on their experiences regarding PPP in RNTCP. Results : It was found that although 50% of private doctors considered three consecutive sputum examinations for acid fast bacilli (AFB), as their most reliable criteria to diagnose pulmonary tuberculosis but this was actually carried out on only 38% of the patients. Various contributing factors cited being, inadequacy of laboratory services in terms of number as well as reliability, poor patient paying capabilities, lack of time and ignorance with the patients and medical practitioners Conclusion : Network of accredited laboratories can increase reliance on sputum microscopy as the diagnostic&treatment tool.

EPA-0024 – Investigating self esteem and attitude toward appearance schema in patients with rhinoplasty

Current study aimed to investigate self esteem and attitude toward Appearance schema in patients with rhinoplasty. In this pretest-posttest semi-experimental design, sample population was consisted of total patients who refered to AmirAlam hospital and a private doctor office for rhinoplasty during the first six-month of 2010. Sampling method was convenient which based on 2 patients per week; the sample size was estimated as 40 persons. The study scales were a demographic questionnaire included variables like age, sex, education, job and the number of rhinoplasty operations. Also, Cooper smith inventory and Appearance schema inventory were used for data gathering. The sample was 40 patients whom 27.5% were male and 72.5% were female. Also 77.5% of them were singles and others were marries. 5% had lower diploma education level, 25% diploma and others had university degrees. Results showed rhinoplasty could not change their self esteem but the scores of attitude toward Appearance befor and after sergury were different (0.05≥p? 39=df? 3.012=t) Before rhinoplasty operation, patients should be assessed psychologically and in should be considered that before rhinoplasty, psychological factors play an important role on increasing self esteem and promoting attitude toward Appearance.

Oscar Wilde, Sodomy, and Mental Illness in Late Victorian England

S i n c e h i S d e a t h i n 1900 O S c a r W i l d e has been many things to many people, from a pariah to a postmodern saint. Frederick Roden, in Same-Sex Desire in Victorian Religious Culture, presents Oscar Wilde as a “queer theologian” by arguing that if “his early catholicism may be denigrated as ‘aesthetic,’ his later soul-searching is decidedly not.” The case for Wilde as being spiritually as well as stylistically inspired by the Gospels relies most powerfully on the letter, styled by Robert Ross as “De Profundis,” that Wilde wrote to his lover Lord alfred “Bosie” Douglas in the early months of 1897. In this work Wilde struggled to make positive sense of his recent experience of humiliation. He sought, through the christian discourse of martyrdom, to elide the inscription of criminality that had been placed on him by worldly authority just as it had similarly been placed on Jesus christ. The most substantial piece of prose that Wilde wrote in prison in the preceding months, however, was a petition for release, sent on 2 July 1896, in which he attempted to use the conceptual realm of mental illness, rather than spiritual illumination, to escape from the constraints of legal classification as a criminal. This choice might be seen as purely opportunistic, since an appeal via the conception of lunacy did provide a recognized legal route out of prison, but it can also be regarded as an act of desperation. after all, those found not guilty by virtue of insanity might be released to the care of a private doctor, as Wilde requested, but they were more likely to be detained in an asylum for the rest of their lives. Reports were obtained—from the prison doctor, from a board of four visitors, and from the superintendent of the

What motivates adherence to medical recommendations? The procedural justice approach to gaining deference in the medical arena

AbstractAlthough it is within their long‐term interest, patients often fail to follow health care recommendations made by medical experts. This failure results in the widespread occurrence of preventable health problems and a significant increase in health care costs. Taking a new approach to confronting this issue, this paper examines whether the procedural justice model, which has been useful in explaining cooperation with legal and managerial authorities, can provide a basis for increasing patients' willingness to voluntarily adhere to health care recommendations. Three studies tested and supported this proposition. Study 1 experimentally manipulated physicians' procedural fairness or unfairness to explore its influence on patients' acceptance of doctors' recommendations. Study 2 used patients' reports about the fairness of their personal physicians and linked those evaluations to their willingness to follow their doctor's recommendations. Finally, study 3 explored the role of general procedural justice judgments in promoting willingness to accept health policies when they are advocated by private doctors and government health care authorities. The results of all three studies support the argument that when health care authorities use fair procedures, patients are more likely to accept their recommendations. Importantly, this procedural justice effect is distinct from, and in some cases stronger than, the influence of competence.

How well can physicians manage Tuberculosis? A Public-Private sector comparison from Karachi, Pakistan

BackgroundTuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan.MethodsThis cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals and private clinics scattered in all eighteen towns of Karachi were included in the study. Qualified MBBS doctors working in any specialty were eligible to participate whereas doctors working in both the public and private sectors were excluded from the study. Vignette based clinical scenarios were given to assess the knowledge score regarding the diagnosis and management of TB.ResultsA total of 196 doctors participated in the study. There was a significant difference between private and public physicians in terms of age and years of practice (p-value <0.05). Significant differences in the proportion of knowledge scores were observed between the public and private doctors and National TB Control Program trained and untrained doctors in Karachi. Factors associated with inadequate knowledge scores were being female gender [OR: 2.76 (95% CI: 1.418-5.384)], private employment status [OR: 1.50 (95% CI: 1.258-2.439)], and not trained by NTP [OR: 2.98 (95% CI: 1.286-3.225)] on multivariate logistic regression analysis.ConclusionIt is concluded that a knowledge gap exists between the public and private doctors in Karachi. Strengthening of currently implemented public private mix model along with improvement in the trainings of public and private practitioners is highly recommended to control TB in Pakistan.

Income-related differences in private doctor visits in Finland, 2005 and 2011

Background According to OECD comparisons, Finland is among the most unequal countries in terms of doctor visits. One reason behind this is that while universal public services are not always easily accessible, private services, partly reimbursed from the social insurance system (22% of costs in 2012), can be used by those who can trade off high co-payments for rapid access to care. However, not much is known on use of private care by socioeconomic groups. The aim of this study is to find out how private …

Medical Returns as Class Transformation: Situating Migrants' Medical Returns within a Framework of Transnationalism

Because studies of migrants' ‘medical returns’ have been largely confined to the field of public health, such forms of return migration are rarely contextualized within the rich social scientific literature on transnational migration. Drawing on ethnographic interviews with Mexican migrants in an immigrant enclave in central California, I show that migrants' reasons for returning to their hometowns for care must be understood within the class disjunctures facilitated by migration. While migrants' Medicaid insurance confined them to public clinics and hospitals in the United States, their migrant dollars enabled them to visit private doctors and clinics in Mexico. Yet medical returns were not mere medical arbitrage, but also allowed migrants to access care that had previously been foreclosed to them as poor peasants in Mexico. Thus crossing the border enabled a dual class transformation, as Mexican migrants transitioned from Medicaid recipients to cash-paying patients, and from poor rural peasants to ‘returning royalty.’

Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934 by Britta McEwen (review)

Reviewed by: Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934 by Britta McEwen Michael Boehringer Britta McEwen, Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934. Austrian and Habsburg Studies 13. New York: Berghahn Books, 2012. 232 pp. In this monograph, based on her 2003 dissertation, Britta McEwen has written a sensitive and thorough examination of the way in which knowledge about sex and sexuality was constructed, negotiated, and distributed in Vienna. Her timeframe is well chosen, beginning with the rapid development of the sexual sciences in the late nineteenth century and ending in February 1934 when the reform efforts in the Social Democrat–governed “Red Vienna” came to a halt in the violent conflicts with the police and the army. McEwen argues convincingly that Vienna occupied a special status during the post–World War I years, not only as the only socialist-run capital in Europe but also as a social-progressive island within a conservative nation. As such, the city-state of Vienna made for a fascinating social laboratory for the construction of sexuality and its meanings in society. While separating her study methodologically from those that link sexuality and nationalism, McEwen does frame it within supra-national discourses on sexuality, Social Darwinism and eugenics, and social pedagogy to form her central thesis, namely that sexual knowledge underwent a fundamental shift from a “form of scientific inquiry practiced largely by medical specialists to a social reform issue engaged by and intended for a wide audience” (2). In order to substantiate her claims, McEwen analyzes a myriad of mostly published yet hitherto largely unexamined texts by public servants and sex reformers close to the Social-Democratic Workers’ Party of Austria and as well as those with allegiances to the Roman Catholic Church, such as sex manuals, [End Page 125] children’s sexual education texts, or municipal reports. She uses a number of analytical tools that can broadly be subsumed under the label of poststructuralist cultural studies: Foucauldian discourse analysis, cultural history of mentalités in the manner of Lucien Febvre or Carlo Ginzburg, and William Reddy’s concept of “emotional regimes,” the cultural process by which emotions are managed and shaped. Common to all these methodologies is their emphasis on the constructedness of knowledge, which McEwen employs for a process-oriented rather than a purely descriptive approach to her topic: “I have sought to understand how people in Vienna thought about sex, what they did with the knowledge, and how that knowledge changed over time” (5). McEwen’s text is made up of six largely self-contained chapters (plus introduction and conclusion), each of which approaches her central theme from a different angle: Chapter 1 focuses on Julius Tandler’s tenure as the minister of public health after World War I and his central role in the creation of Vienna’s health and hygiene system. Tandler promoted a specifically Viennese form of eugenics called “productive population politics” (44) to bring about the repair of national health and a national regeneration through state-prescribed sexual hygiene as well as support for families, unwed mothers, and illegitimate children. In the process, McEwen argues, Tandler created an official language of sexual knowledge that would find widespread use and initiated the shift away from private doctors to public servants in the delivery of sexual health services. Chapter 2 analyzes various approaches to sexual education during the interwar period. McEwen outlines the efforts of sexual reformers to replace religious doctrine with scientifically based knowledge about the body and sexuality and the resulting counter-discourse put forward by the Catholic Church. McEwen demonstrates that the respective positions were not monolithic but allowed for considerable overlap, especially around the themes of the naturalness of (heterosexual) desire, its sublimation through self-restraint and individual responsibility, marriage, and motherhood. These last two aspects also form the central focus of the third chapter. Here McEwen argues that the heterosexual couple was the principal object of the sexual reform movement, with women having a special role in protecting their reproductive capacities (and that of their partners) through the acquisition of anatomical knowledge and the prevention of disease and unwanted pregnancy. The literary model of the...

Diagnosis and Treatment of Leprosy Reactions in Integrated Services - The Patients' Perspective in Nepal

Leprosy care has been integrated with peripheral health services, away from vertical programmes. This includes the diagnosis and management of leprosy reactions, which cause significant morbidity. We surveyed patients with leprosy reactions at two leprosy hospitals in Nepal to assess their experience of leprosy reaction management following integration to identify any gaps in service delivery.MethodsDirect and referral patients with leprosy reactions were interviewed in two of Nepal's leprosy hospitals. We also collected quantitative and qualitative data from clinical examination and case-note review to document the patient pathway.ResultsSeventy-five patients were interviewed. On development of reaction symptoms 39% presented directly to specialist services, 23% to a private doctor, 17% to a district hospital, 10% to a traditional healer, 7% to a health post and 4% elsewhere. Those who presented directly to specialist services were 6.6 times more likely to start appropriate treatment than those presenting elsewhere (95% CI: 3.01 to 14.45). The average delay between symptom onset to commencing corticosteroids was 2.9 months (range 0–24 months). Obstacles to early presentation and treatment included diagnostic challenge, patients' lack of knowledge and the patients' view of health as a low priority. 40% received corticosteroids for longer than 12 weeks and 72% required an inpatient stay. Treatment follow-up was conducted at locations ranging from health posts to specialist hospitals. Inconsistency in the availability of corticosteroids peripherally was identified and 41% of patients treated for leprosy and a reaction on an outpatient basis attended multiple sites for follow-up treatment.ConclusionThis study demonstrates that specialist services are necessary and continue to provide significant critical support within an integrated health system approach towards the diagnosis and management of leprosy reactions.

Prevalence of symptoms suggestive of reproductive tract infections/sexually transmitted infections in women in an urban area of Ludhiana

RTIs/STIs present a huge burden of disease, adversely impact reproductive health, and cause suffering for both men and women with consequences more devastating and widespread among women. These infections often go undiagnosed and untreated. 1) To identify the most common reported symptoms of RTI/STI among married women aged 15-44 years in an urban population of Ludhiana. 2) To identify important risk factors associated with symptoms of RTI/STI in the study population. A cross-sectional study was carried out among married women aged 15-44 years in an urban area in Ludhiana, using the WHO-Syndromic Approach for diagnosis and management of RTIs/STIs. The sample consisted of 260 eligible women obtained by systematic random sampling, from amongst those residing in the population served by one MPHW (F). The prevalence of symptoms suggestive of RTIs/STIs in the study population was found to be 17.3%. The most common symptoms reported by the women sufferers were urinary (dysuria 57.8%, frequent urination 53.3%), followed by dyspareunia (26.7%), unusual vaginal discharge (24.4%) and vaginal itching (22.2%). Age 35-44 years, gravidity >4, education high school/above, joint families, history of abortion, and using ordinary cloth during menstruation were found to be significant risk factors. 64.4% of those with symptoms were untreated, 68.7% of those treated reported partial relief, most of those treated preferred private doctors, and the partners were not treated.

Health-seeking behavior of rural agricultural workers: A community-based cross-sectional study

Context: Majority of the Indian population lives in rural area, where the main occupation is agriculture. In developing countries, agriculture workers have multitude of health problems, whereas they do not have access to the adequate health care facilities. Aims: The present study was aimed to know the health-seeking behavior of agricultural workers. Settings and Design: This cross-sectional study was done from January 2009 to December 2009 in a rural area of Bhutaramanahatti sub-center (Vantamuri PHC), Belgaum District. Materials and Methods: A total of 400 agricultural workers of age 16-60 years were interviewed in their households/fields. Data were acquired on a predesigned and pretested questionnaire. Statistical Analysis Used: Percentages and Chi-square test. Results: Among the study participants 55.75% were males and 44.25% were females, with a male to female ratio of 1.25:1. Most of the agricultural workers (89.5%) were Hindus, 10.5% were Muslims, and 47% were illiterates, whereas 38% had passed first to fifth grades, 14.5% had passed sixth to tenth grades, and 0.5% had attended tenth plus. Of the 400 subjects, 295 (73.75%) belonged to Class V socioeconomic status. Overall, 48.75% opted government doctors and 28% opted private doctors as the first priority health care providers for their illness. 37.75% preferred private or AYUSH practitioners and 18.25% opted government doctors in case illness was not cured or they were not satisfied with the treatment given by the first health care provider. Conclusions: The present study reveals that most of the agricultural workers depended on government doctor for their illness. In order to overcome the situation, special health check-up camps need to be conducted with emphasis on improvement of health.